Patient securement system for the surgical Trendelenburg position

ABSTRACT

A patient securing overlay is provided that includes a sheet of fabric for supporting a patient&#39;s torso on a surgical table. The sheet of fabric has an upper surface configured to face the patient and a lower surface configured to face a surgical table mattress or underbody support. The sheet of fabric includes friction enhancing elements applied to at least a portion of the upper surface thereof. The sheet of fabric can include an extension at a foot end of the sheet of fabric that provides material to be tucked under a foot end of the surgical table mattress or underbody support for securing the foot end of the sheet of fabric to the surgical table mattress or underbody support. The extension can include one or more friction enhancing elements.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.16/941,823, filed Jul. 29, 2020, which is a continuation of U.S.application Ser. No. 16/780,136, filed Feb. 3, 2020 and which issued asU.S. Pat. No. 10,765,580 on Sep. 8, 2020, which claims priority to U.S.Provisional Patent Application No. 62/824,911, filed Mar. 27, 2019, theentire contents of each of which are incorporated herein by reference.

BACKGROUND OF THE INVENTION

Keeping the patient from sliding off of a surgical table when the tableis tilted into a steep, head-down (Trendelenburg) position, is aconstant challenge for surgical personnel and a danger for the patient.This problem has gotten worse in recent years with the advent oflaparoscopic surgery and particularly with the advent of roboticsurgery. In both of these instances, the patients are regularly placedinto the steep Trendelenburg position so that gravity can move theinternal organs out of the way of the laparoscopes. Depending on theangle or steepness of the head-down Trendelenburg positioning, thepatient's weight, and the make-up of the support surface (e.g., bedsheets), patients can be at risk of sliding off of the head end of thesurgical table in the Trendelenburg position. This is especially truefor pelvic surgery (e.g. rectal, gynecological, and urological), wherethe head of the surgical table may be tilted as much as 45° downward inorder to use gravity to move the bowels and other internal organs awayfrom the pelvis to improve the view of the surgical site.

Many types of patient securement devices have been tried over the years.In general, there are several categories of securement devices,including: straps and tape; shoulder bolsters; foam surgical tableoverlays; bean bags that mold around the patient; and gel pads thatstick to the patient. Straps and tape across the chest have proven tonot be secure. Straps over the shoulders have resulted in stretchinjuries to the nerves of the brachial plexus. Similarly, bolsters offoam or bean bags at the patient's shoulders that are secured to theside rails of the bed have also resulted in stretch injuries to thenerves of the brachial plexus and are not recommended by the Associationfor Operating Room Nurses. Gel pads are cold and messy becauseeverything sticks to them.

Foam surgical table overlays have become the standard securementdevices. The foam is generally sized to cover the section of thesurgical table that supports the patient's torso and head. Irrespectiveof the foam's coefficient of friction against the patient's skin, thesmooth surface of the surgical mattress usually creates a lowercoefficient of friction between the foam and the mattress than thecoefficient of friction between the foam and the patient. Therefore,unwanted slipping is most likely to occur between the mattress and thefoam surgical table overlay. In order to improve the connection betweenthe mattress and the foam surgical table overlay, the foam overlay istypically taped or strapped to the side rails of the surgical table.However, tape sticking to a foam surgical table overlay or straps gluedto a foam surgical table overlay as described in U.S. Pat. No.8,464,720, for example, have a significant risk of becoming unattachedwhen the weight of a 400 pound patient is applied at a 45° head-downangle. Either the adhesive fails or the top layer of foam pulls awayfrom the foam surgical table overlay while still being adhered to thetape.

Some known devices, as described in U.S. Pat. No. 10,045,902 forexample, advocate for the use of thicker foam pads, such as viscoelasticpads having a thickness in the range of from three-fourths of an inch tothree inches or greater to permit formation of a depression having adepth sufficient to assist in holding a patient on the pad. In thepresent disclosure, we refer to the formation of a depression having adepth sufficient to assist in holding a patient on the pad as a “bolstereffect.” The disadvantage of any securement device relying wholly or inpart on a bolster effect is that bolster-type securement can beoverpowered by excessive weight and rounded shaped shoulders that arecommon with obesity. Therefore, securement devices that rely in part ona bolster effect must provide instructions for use that limit both theweight of the patient and the angle of decline.

Patients in the Trendelenburg position, especially for robotic surgery,conventionally have their arms tucked along the sides of their bodies.Certain conventional arm protection and securing devices are cumbersome,bulky, expensive, and prevent heating of the arms. Known methods oftucking the arms at the patient's sides with or without an armprotection device rely on wrapping the arms in a draw sheet and tuckingthe ends of the draw sheet under the patient. The tucked ends of thedraw sheet can easily become un-tucked, simply pulling out from underthe patient and allowing the arm to fall toward the floor, which maycause nerve injuries.

Robotic surgeries can usually take longer to perform than open surgeriesand thus the patients frequently get more hypothermic in the coldoperating rooms. With the patient's arm tucked at their sides, the onlyskin surface area available for conventional forced-air warming, is thetop of the shoulders and the head and thus forced-air warming isineffective. As a result, most patients operated in either theTrendelenburg position or the supine position with their arms tucked andwarmed with forced-air warming, become very hypothermic. The sameincreased risk of hypothermia is experienced by other patientspositioned with their arms tucked but not in the Trendelenburg (headdown) position.

It would be desirable to provide reliable, safe, and convenient patientsecurement devices to stabilize the patient on the surgical table forthe Trendelenburg and other unusual positions. It would also bedesirable to provide improved patient warming devices for use duringsurgery in the Trendelenburg position. In addition, it would bedesirable to provide better arm protection and securing devices for useduring surgery in the Trendelenburg position. Still further, it would bedesirable to provide better patient warming devices, better armprotection, and better arm securing devices for use during surgery inthe flat supine position with the patient's arms tucked.

SUMMARY OF THE INVENTION

The underbody support mattresses and blankets of this disclosure areintended for use in medical settings generally. These include theoperating room, the emergency room, the intensive care unit, hospitalrooms, nursing homes, and other medical treatment locations.

Various embodiments include flexible and conformable heated underbodysupports including mattresses, mattress overlays, and pads for providingtherapeutic warming to a person, such as to a patient in an operatingroom setting. In various embodiments, the heated underbody support ismaximally flexible and conformable allowing the heated surface to deformand accommodate the person without reducing the accommodation ability ofany underlying mattress, for example.

In some embodiments, a sheet of fabric or other material that has beenat least partially coated on both sides with friction-enhancingelements, such as high-friction plastic or rubber, may be interposedbetween the patient and the underbody support in order to increase thecoefficient of friction therebetween. An example of suchfriction-enhancing elements may be a PVC foam or silicone rubber appliedas a pattern of three-dimensional raised dots onto a sheet of fabric.

In some embodiments, heated blankets may be positioned along the sideedges of the underbody support and held in place by attaching them to abase film layer that crosses the surgical mattress from side to side. Insome embodiments, heated blankets may be attached to the side edges ofthe underbody support. The heated blankets may be wrapped around thepatient's arms to provide additional heating as well as support,securement, and protection of the arms and hands.

Certain embodiments provide a patient securing overlay with securementto a surgical table mattress or underbody support for use during surgeryin the Trendelenburg position. The patient securing overlay includes asheet of fabric configured to support a patient's torso on a surgicaltable. The sheet of fabric has an upper surface configured to face thepatient and a lower surface configured to face the surgical tablemattress or underbody support. The sheet of fabric includes frictionenhancing elements applied to at least a portion of the upper surface.The sheet of fabric includes an extension at a foot end of the sheet offabric that provides material to be tucked under a foot end of thesurgical table mattress or underbody support for securing the foot endof the sheet of fabric to the surgical table mattress or underbodysupport. The extension at the foot end of the sheet of fabric includesone or more friction enhancing elements that improve the friction bondbetween the sheet of fabric and either an underside of the surgicaltable mattress or underbody support. The extension at the foot end ofthe sheet of fabric is narrower than the sheet of fabric and anchorsagainst a perineal cutout in the surgical table mattress or theunderbody support such that the extension stretches to create a forcevector that is directly opposite a force vector associated with thepatient sliding down an incline of the surgical table when the surgicaltable is in the Trendelenburg position.

Certain other embodiments provide a patient securing overlay withsecurement to an unheated underbody support for use during surgery inthe Trendelenburg position. The patient securing overlay includes anunheated underbody support that is secured to side rails of a surgicaltable, and a sheet of fabric that is configured to support a patient'storso on the surgical table. The sheet of fabric has an upper surfaceconfigured to face the patient and a lower surface configured to facethe unheated underbody support. The sheet of fabric includes frictionenhancing elements applied to at least a portion of the upper surfacethereof. The sheet of fabric also includes an extension at the foot endof the sheet of fabric that provides material to be tucked under a footend of the unheated underbody support for securing the foot end of thesheet of fabric to the unheated underbody support. The extension at thefoot end includes an anchor that comprises a planar sheet of materialthat comprises plastic, metal, or fiberboard. The anchor is removablyinsertable between a bottom of the unheated underbody support and a topof the surgical table mattress at the foot end of the unheated underbodysupport. The extension of the sheet of fabric at the foot end anchorsagainst the foot end of the unheated underbody support such that theextension stretches to create a force vector that is directly oppositethe force vector associated with the patient sliding down an incline ofthe surgical table when the surgical table is in the Trendelenburgposition.

Certain other embodiments provide a patient securing overlay withadjustable securement to a surgical table mattress for use duringsurgery in the Trendelenburg position. The patient securing overlayincludes a sheet of fabric configured to support a patient's torso on asurgical table. The sheet of fabric has an upper surface configured toface the patient and a lower surface configured to face the surgicaltable mattress. The sheet of fabric includes friction enhancing elementsapplied to at least a portion of its upper surface. The sheet of fabricincludes an extension at the foot end of the sheet of fabric thatprovides material to be tucked under a foot end of the surgical tablemattress for securing the foot end of the sheet of fabric to thesurgical table mattress. The extension at the foot end of the sheet offabric is narrower than the sheet of fabric and includes an anchor thatcomprises a planar sheet of material that comprises plastic, metal, orfiberboard. The anchor is removably insertable between a bottom of thesurgical table mattress and a top of the surgical table at the foot endof a section of the surgical table mattress that is configured tosupport the patient's torso. The extension of the sheet of fabric at thefoot end of the sheet of fabric anchors against a perineal cutout in thesurgical table mattress such that the extension stretches to create aforce vector that is directly opposite a force vector associated withthe patient sliding down an incline of the surgical table when thesurgical table is in the Trendelenburg position.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an underbody support attached to asurgical table in accordance with illustrative embodiments.

FIG. 2 is a side view of a patient lying on a surgical table in theTrendelenburg position in accordance with illustrative embodiments.

FIG. 3 is a top view of a surgical table with the foot section loweredand stirrups attached for the lithotomy position in accordance withillustrative embodiments.

FIG. 4 is a side view of a patient laying on a surgical table andunderbody support, in the lithotomy and Trendelenburg positions inaccordance with illustrative embodiments.

FIG. 5 is a perspective view of a securement pad in accordance withillustrative embodiments.

FIG. 6 is a side view of a patient laying on a surgical table andsecurement pad, in the lithotomy and Trendelenburg positions inaccordance with illustrative embodiments.

FIG. 7A is a side view of a patient laying on a surgical table,underbody support and sheet of fabric, in the lithotomy andTrendelenburg positions in accordance with illustrative embodiments.

FIG. 7B is a side view of a surgical table with an underbody support andsheet of fabric in the Trendelenburg position, in accordance withillustrative embodiments.

FIG. 8 is a detailed perspective view of a sheet of fabric, inaccordance with illustrative embodiments.

FIG. 9 is a detailed top view of a sheet of fabric, in accordance withillustrative embodiments.

FIG. 10 is a detailed cross-sectional view of a sheet of fabric takenalong line 10-10 of FIG. 9, in accordance with illustrative embodiments.

FIG. 11 is a detailed cross-sectional view of a sheet of fabric takenalong line 10-10 of FIG. 9, positioned between the patient and theunderbody support in accordance with illustrative embodiments.

FIG. 12 is a detailed top view of the scrim, in accordance withillustrative embodiments.

FIG. 13 is a detailed cross-sectional view of a sheet of fabric takenalong line 10-10 of FIG. 9, in accordance with illustrative embodiments.

FIG. 14 is a detailed cross-sectional view of a sheet of fabric takenalong line 10-10 of FIG. 9, in accordance with illustrative embodiments.

FIG. 15 is a perspective view of a sheet of fabric with a layer of foammaterial in accordance with illustrative embodiments.

FIG. 16 is a longitudinal section view of a surgical table mattress witha sheet of fabric in accordance with illustrative embodiments.

FIG. 17 is a longitudinal section view of an anchor in accordance withillustrative embodiments.

FIG. 18 is a longitudinal section view of a surgical table mattress witha sheet of fabric and an anchor in accordance with illustrativeembodiments.

FIG. 19 is a longitudinal section view of a surgical table mattress witha sheet of fabric and an anchor in accordance with illustrativeembodiments.

FIG. 20A is a longitudinal section view of a surgical table mattresswith a sheet of fabric and an anchor in accordance with illustrativeembodiments.

FIG. 20B is a longitudinal section view of a surgical table mattresswith a sheet of fabric and an anchor in accordance with illustrativeembodiments.

FIG. 20C is a longitudinal section view of a surgical table mattresswith a sheet of fabric and an anchor in accordance with illustrativeembodiments.

FIG. 21 is a longitudinal section view of a surgical table mattress witha sheet of fabric and an anchor in accordance with illustrativeembodiments.

FIG. 22 is a longitudinal section view of a surgical table mattress inaccordance with illustrative embodiments.

FIG. 23 is a perspective view of a draw sheet over an underbody supportattached to a surgical table in accordance with illustrativeembodiments.

FIG. 24 is a perspective view of a draw sheet over an underbody supportattached to a surgical table in accordance with illustrativeembodiments.

FIG. 25 is a longitudinal section view of a draw sheet in accordancewith illustrative embodiments.

FIG. 26 is a longitudinal section view of a draw sheet in accordancewith illustrative embodiments.

FIG. 27 is a perspective view of an underbody support with arm-securingflaps attached to a surgical table in accordance with illustrativeembodiments.

FIG. 28 is a perspective view of an underbody support with arm-securingflaps in accordance with illustrative embodiments.

FIG. 29 is a perspective view of an underbody support with arm-securingflaps attached to a surgical table in accordance with illustrativeembodiments.

FIG. 30 is a top view of arm-securing flaps with a base sheet of fabricor film in accordance with illustrative embodiments.

FIG. 31 is a top view of arm-securing flaps with base straps inaccordance with illustrative embodiments.

FIG. 32 is a cross-sectional view of an arm-securing flap wrapped arounda patient's arm in accordance with illustrative embodiments.

FIG. 33 is a cross-sectional view of a draw sheet wrapped around apatient's arms in accordance with illustrative embodiments.

FIG. 34 is a side view of a patient laying on a surgical table andunderbody support with arm-securing flaps in the lithotomy andTrendelenburg positions in accordance with illustrative embodiments.

FIG. 35A is a cross-sectional view of an arm-securing flap wrappedaround a patient's arm with a draw sheet in accordance with illustrativeembodiments.

FIG. 35B is a cross-sectional view of an arm-securing flap wrappedaround a patient's arm with a draw sheet in accordance with illustrativeembodiments.

FIG. 36 is a perspective view of an underbody support with arm-securingflaps attached to a surgical table in accordance with illustrativeembodiments.

FIG. 37 is a perspective view of an underbody support with arm-securingflaps and a surgical table cover attached to a surgical table inaccordance with illustrative embodiments.

FIG. 38 is a side view of a patient laying on a surgical table andunderbody support with chest straps securing a heated blanket in thelithotomy and Trendelenburg positions in accordance with illustrativeembodiments.

FIG. 39 is a perspective view of a surgical table with a slide sheet anddraw sheet in accordance with illustrative embodiments.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

The following detailed description is exemplary in nature and is notintended to limit the scope, applicability, or configuration of theinvention in any way. Rather, the following description providespractical illustrations for implementing various exemplary embodiments.Examples of constructions, materials, dimensions, and manufacturingprocesses are provided for selected elements, and all other elementsemploy that which is known to those of skill in the field. Those skilledin the art will recognize that many of the examples provided havesuitable alternatives that can be utilized.

In some embodiments, as shown in FIG. 1, embodiments include underbodysupports such as heated underbody supports, including heated mattresses,heated mattress overlays, and heated pads. The term underbody supportmay be considered to encompass any surface situated below and supportinga user in a generally recumbent position, such as a patient who may beundergoing surgery, including heated mattresses, heated mattressoverlays and heated pads.

Heated mattress overlay embodiments may be identical to heated padembodiments, with the only difference being whether or not they are usedon top of a mattress. Furthermore, the difference between heated padembodiments and heated mattress embodiments may be the amount of supportand accommodation they provide, and some pads may be insufficientlysupportive to be used alone like a mattress. As such, the variousaspects which are described herein apply to mattresses, mattress overlayand pad embodiments, even if only one type of support is shown in thespecific example.

While there is repeated reference to “heated underbody supports” in thisdisclosure, skilled artisans will appreciate that the heat feature isnot a necessary component of every embodiment. Non-heated underbodysupport embodiments are also anticipated.

In some embodiments, the heated underbody support includes a heaterassembly and a layer of compressible material. The heater assembly mayinclude a heating element including a sheet of conductive fabric havinga top surface, a bottom surface, a first edge, an opposing second edge,a length, and a width. The conductive fabric may include threadsseparately and individually coated with an electrically conductive orsemi-conductive material, with the coated threads of the fabric beingable to slide relative to each other such that the sheet is flexible andstretchable. In some embodiments, the conductive fabric may be made withthreads that are conductive such as carbon fiber. In some embodiments,the sheet is made with conductive ink applied to a polymeric film suchas polyester film and is therefore not made with conductive fabric. Insome embodiments, the heater is made of conductive film such as carbonor graphite-loaded plastic film.

The heater assembly may also include a first bus bar extending along theentire first edge of the heating element and adapted to receive a supplyof electrical power, a second bus bar extending along the entire secondedge of the heating element, and a temperature sensor. The layer ofcompressible material may be adapted to conform to a person's body underpressure from a person resting upon the support and adapted to return toan original shape when pressure is removed. It may be located beneaththe heater assembly and may have a top surface and an opposing bottomsurface, a length, and a width, with the length and width of the layerbeing approximately the same as the length and width of the heaterassembly.

In some embodiments, the bus bars may be braided wire. In someembodiments, it may be desirable to coat the bus bars with a flexiblerubber material such as silicone rubber, during construction of theheater. While braided wire is relatively tolerant of repeated flexion,if the flexion occurs enough times at the same spot, even braided wirebus bars can fracture and fail. Coating the bus bars with siliconerubber can significantly increase the durability of the bus bars tosurvive repeated flexion.

In some embodiments, the conductive or semi-conductive material ispolypyrrole. In some embodiments, the compressible material includes afoam material, and in some embodiments it includes one or more airfilled chambers. In some embodiments, the heated underbody support alsoincludes a water resistant shell encasing the heater assembly, includingan upper shell and a lower shell that can be sealed together along theiredges to form a bonded edge, with the heater assembly attached to theshell only along one or more edges of the heater assembly. In someembodiments, the heating element has a generally planar shape when notunder pressure. The heating element is adapted to stretch into athree-dimensional compound curve without wrinkling or folding whilemaintaining electrical conductivity in response to pressure, and mayreturn to the same generally planar shape when pressure is removed.

In some embodiments, the heated underbody support includes a heaterassembly including a flexible heating element comprising a sheet ofconductive fabric having a top surface, a bottom surface, a first edgeand an opposing second edge, a length, and a width, a first bus barextending along the first edge of the heating element and adapted toreceive a supply of electrical power, a second bus bar extending alongthe second edge of the heating element, and a temperature sensor. Theunderbody support may further include a layer of compressible supportmaterial located beneath the heater assembly, which conforms to apatient's body under pressure and returns to an original shape whenpressure is removed.

In some such embodiments, the heating element includes a fabric coatedwith a conductive or semi-conductive material, which may be a carbon ormetal containing polymer or ink, or may be a polymer such aspolypyrrole. In some embodiments, the heated underbody support alsoincludes a shell including two sheets of flexible shell materialsurrounding the heater assembly, the shell being a water resistantplastic film or fiber reinforced plastic film with the two sheets sealedtogether near the edges of the heater assembly. In some embodiments, theheated underbody support also includes a power supply and controller forregulating the supply of power to the first bus bar.

In some such embodiments, the compressible material is a foam material.The heater assembly may be attached to the top surface of the layer ofcompressible material. In some embodiments, the heated underbody supportincludes a water-resistant shell encasing the heater assembly and havingan upper shell and a lower shell that are sealed together along theiredges to form a bonded edge. In some such embodiments, one or more edgesof the heater assembly may be sealed into the bonded edge. In someembodiments, the heater assembly is attached to the upper layer ofwater-resistant shell material. In some embodiments, the heater assemblyis attached to the shell only along one or more edges of the heaterassembly. In some embodiments, the heated underbody support alsoincludes an electrical inlet, wherein the inlet is bonded to the uppershell and the lower shell and passes between them at the bonded edge.

In some embodiments, the temperature sensor is adapted to monitor atemperature of the heating element and is located in contact with theheating element in a substantially central location upon which a patientwould be placed during normal use of the support. In some embodiments,the heated underbody support also includes a power supply and acontroller for regulating a supply of power to the first bus bar. Someembodiments of heating pads and mattresses have been disclosed in U.S.Pat. Nos. 8,604,391; 9,962,122; 10,201,935; and 10,206,248, the entiredisclosures of which are incorporated by reference into the presentdisclosure.

Certain embodiments of the invention include an electric heating blanketincluding a flexible sheet-like heating element and a shell. In someembodiments, the heating element is similar to those previouslydescribed and disclosed for surfaces of heated underbody supports. Theshell covers the heating blanket and includes two sheets of flexiblematerial welded together. In some embodiments, the weld couples thesheets together about the edges of the heating element. In someembodiments, the weld couples the sheets about the edges of the sheets.Some embodiments of heating blankets have been disclosed in U.S. Pat.Nos. 8,283,602 and 8,772,676, the entire disclosures of which areincorporated by reference into the present disclosure.

The steep Trendelenburg position is often used during urological,gynecological and colorectal surgery, especially if the surgery is donewith robotic or laparoscopic techniques. As shown in FIG. 2, the patient2 is typically positioned supine on the surgical table 4 with their legselevated in stirrups 6. In some cases, each stirrup 6 is shownindividually in the drawings as reference numerals 6A and 6B. Thesurgical table 4 can optionally comprise metal. The foot end 8 of thesurgical table 4 is lowered to allow the surgeon or robot access to theperineum of the patient. The steep Trendelenburg position allows gravityto pull the abdominal contents out of the pelvis for unobstructed accessand visualization with the laparoscope. The patient's buttock istypically positioned at the foot end 10 of the underbody support or atthe foot end 10 of the section 12 of the surgical table mattress 30 thatsupports the torso of the patient 2. The foot end 10 of the underbodysupport 16 or section 12 of the surgical table mattress 30 that issupporting the patient's torso typically has a notch cut out of themiddle of the foot end, known as the perineal cutout 14, as shown inFIG. 3. The perineal cutout 14 allows the patient's perineum to hangslightly over the end of the center of the surgical table mattress 30while still providing support on the lateral aspects of the buttock whenthe legs are elevated. The perineal cutout aids in unobstructed accessto the patient's perineum by the surgeon or robot.

The underbody support 16 may include elements for anchoring theunderbody support 16 to the surgical table 4. In some embodiments, theelements for anchoring may be a Velcro attachment between the uppersurface of the surgical table 4 and the lower surface of the underbodysupport 16. The lower surface may also be called the table interfacesurface.

In some embodiments, the elements for anchoring the underbody support 16may be a strap attachment between the side of the surgical table 4 andthe durable shell of the underbody support 16. As shown in FIG. 4, thestraps 18 of the strap attachment may be made of non-stretching,reinforced strap material that can be looped around the side rails 20 ofthe surgical table 4 and then secured back onto itself. In some cases,the straps 18 are shown individually in the drawings as referencenumerals 18A and 18B. The straps 18A, 18B may be secured with buttons,snaps, hooks, barbs, Velcro, or any other suitable secure attachment. Insome embodiments, the straps 18A and 18B may be attached to theunderbody support 16 at one or more strap attachment protrusions 22 ofthe upper and lower shell material layers, from the side of theunderbody support 16. The one or more strap attachment protrusions 22may be part of the perimeter weld between the upper and lower shellmaterial layers of the underbody support 16, previously discussed. Theone or more strap attachment protrusions 22 may be reinforced with amesh of fibers such as nylon for added strength.

In some embodiments, the shell material of the underbody support 16 maybe reinforced with a mesh of fibers such as nylon embedded in the shellmaterial during the shell material extrusion process. The fiberreinforcement may be included in the lower shell layer, the upper shelllayer, or in both shell layers. The reinforcing fibers prevent the shellmaterial from stretching and deforming when a heavy patient is placed inthe steep Trendelenburg position, creating a sliding force between thelayers of the underbody support or between the underbody support 16 andthe surgical table mattress 30 or the surgical table top 64. Thisreinforced construction of the underbody support 16 in conjunction withthe reinforced construction of the strap attachment protrusions 22 ofthe underbody support 16 together with the reinforced construction ofthe straps 18A, 18B connected to the side rails 20 of the surgical table4, or Velcro attachment to the surgical table top 64, assures that theunderbody support 16 will remain stable and not shift or slide when thepatient is placed in the steep Trendelenburg position. In someembodiments, the durable construction of this underbody support 16prevents deformation and stretching in any direction parallel to theplane of the support, thus preventing slippage between the underbodysupport 16 and the surgical table 4. The stability and inability todeform in response to the weight of the patient pulling the patient downthe slope of the surgical table 4 provided by this construction, is incontrast to the relatively fragile and flexible construction ofconventional disposable securement pads. As shown in FIGS. 5 and 6,conventional (e.g., flexible) securement pads 26 will easily deform inresponse to forces applied parallel to the plane of the securement pad26, and this deformation results in slippage between the securement pad26 and a section 12 of the surgical table mattress 30.

Additionally, as shown in FIG. 5, such type of securement pad 26includes pad straps 28A, 28B that anchor the securement pad 26 to theside rails 20 of the surgical table 4. However, as shown in FIG. 6,anchoring these types of securement pads 26 to the side rails 20 allowsa natural 1-3 inches of slippage between the securement pad 26 and thesurgical table 4. This slippage in this type of securement pad 26 is dueto the force of the patient's weight being applied perpendicularly tothe direction of the pad straps 28A, 28B that are nondurable andstretchable and glued to the securement pad 26 that is typically made ofa stretchable sheet of flexible viscoelastic foam. These pad straps 28A,28B, which are perpendicularly oriented, nondurable, flexible, andstretchable, in conjunction with the conventional securement pad 26(which is often a flexible and deformable foam) stretch and flex incombination, allowing the securement pad 26 to slide down the surgicaltable mattress 30 up to three inches in the steep Trendelenburgposition, before arresting the slide. A sliding motion down the steepincline of the table cannot be prevented when perpendicular forces tothe side rails 20 are applied to pad straps 28A, 28B that are glued tothe securement pad 26 (when such pad is a flexible foam pad). The siderails 20 of the surgical table 4 are a convenient attachment point forknown devices but cannot prevent 1-3 inches of sliding down the inclineof a surgical table 4 in the Trendelenburg position using the pad straps28A, 28B and securement pad 26 described above.

In some embodiments, as shown in FIGS. 7A and 7B, a sheet of fabric 32that has been at least partially coated on both sides withfriction-enhancing elements 34 may be interposed between the patient 2and the underbody support 16 in order to increase the coefficient offriction therebetween. In any embodiment described herein, the sheet offabric 32 can be separate from the underbody support 16 and removablypositionable onto the underbody support 16. The friction-enhancingelements 34 may be high-friction plastic or rubber, or a material havingsimilar characteristics. An example of material for thefriction-enhancing elements 34 may be PVC, silicone, polyethylene orother plastic or rubber materials that may be applied as athree-dimensional pattern or three-dimensional raised dots onto afabric. As shown in FIGS. 8 and 9, the friction-enhancing elements 34may be in the form of a pattern or dots, and grip the upper surface ofthe underbody support 16 on one side and the back of the patient 2 ontheir other side, dramatically increasing the coefficient of frictionbetween the patient 2 and a surface of the underbody support 16,preventing the two from slipping against each other. Alternately, thefriction-enhancing elements 34 may be applied directly to the uppersurface of the underbody support 16. The upper surface may also becalled a patient interface surface.

In some embodiments, a sheet of fabric 32 is interposed between theupper surface of the underbody support 16 and the back of the patient 2in order to increase the coefficient of friction between these twosurfaces. The sheet of fabric 32 may be either woven or non-woven andmay be made of any durable fiber such as polyester, rayon, nylon orcotton. Other fibers for the sheet of fabric 32 are also anticipated. Insome embodiments, if a fluid impervious layer is desirable, the sheet offabric 32 in this disclosure may be made of plastic film or plastic filmcoated or laminated onto one or both sides of a sheet of fibrous fabric.The plastic film layer may be made of polyethylene, polypropylene, PVC,urethane or other suitable films.

In some embodiments, the sheet of fabric 32 is partially coated on atleast its upper surface 36 with friction-enhancing elements 34. Thefriction-enhancing elements 34 can be a plastic or rubberthree-dimensional friction-enhancing elements, such as athree-dimensional raised pattern of circular, square, rectangular oroblong elements. In some embodiments, the friction-enhancing elements 34are between 0.1 inches and 0.5 inches in diameter or cross section. Thefriction-enhancing elements 34 include but are not limited to: PVCfoams, viscoelastic PVC foams, silicone, viscoelastic polyurethanefoams, other viscoelastic polymeric foams, urethane, PVC, as well asother polymers and rubbers.

In some embodiments, as shown in FIGS. 10 and 11, the sheet of fabric 32is partially coated on both the upper surface 36 and the lower surface38 with friction-enhancing elements 34. The friction-enhancing elements34 can be plastic or rubber three-dimensional friction-enhancingelements, such as a three-dimensional raised pattern of circular,square, rectangular or oblong elements. In some embodiments, thefriction-enhancing elements 34 on the upper surface 36 and lower surface38 are three-dimensional friction-enhancing elements that directlyoppose each other in size and location on each side of the sheet offabric 32. As used herein, friction-enhancing elements 34 that directlyoppose each other in both size and location refers to friction-enhancingelements 34 that are positioned directly opposite one another onopposite sides of the sheet of fabric 32 and that have the exact samedimensions (or substantially the same dimensions) as each other. Directopposition of the friction-enhancing elements 34 on both sides of thesheet of fabric 32 improves the transmission of force between the uppersurface of the underbody support 16 and the patient's back, at thatpoint. The ability of the friction-enhancing elements 34 on each side ofthe sheet of fabric 32 to increase the coefficient of friction byindenting the patient's back 2 on one side and the underbody support 16on the other side is reduced if the friction-enhancing elements 34 oneach side of the sheet of fabric 32 are not directly opposing eachother. In some embodiments, the friction-enhancing elements 34 arethree-dimensional friction-enhancing elements intended to press into thepatient's skin creating a small indentation that adds to the mechanicalinteraction between the sheet of fabric 32 and the patient's skin. Thismechanical interaction between the sheet of fabric 32 and the patient'sskin, indenting the skin, augments the normal coefficient of frictionbetween the two surfaces. Locating the friction-enhancing elements 34directly opposing each other on each side of the sheet of fabric 32,maximizes the ability of each friction-enhancing element 34 to transmitforce from the underbody support 16 to the patient's back.

In some embodiments, as shown in FIGS. 9, 10 and 11, thefriction-enhancing elements 34 on the upper surface 36 of the sheet offabric 32, which can be a three-dimensional raised pattern offriction-enhancing elements, may form a matrix leaving the sheet offabric 32 with holes 40 in the areas between the raised pattern offriction-enhancing elements. The holes 40 in the sheet of fabric 32 mayadvantageously allow the free passage of heat, air and moisture throughthe sheet of fabric 32. When the underbody support 16 is a heatedunderbody support, the holes 40 allow heat from the underbody support 16to freely pass through the sheet of fabric 32 to the patient to provideeffective warming. This is in contrast to the thermally insulatingquality of conventional securement pads 26 (e.g., comprising foam) thatprevent effective underbody patient warming. The holes 40 in the sheetof fabric 32 of the present disclosure may also advantageously allow thefree passage of moisture through the sheet of fabric 32, removing theperspiration or skin prep antiseptic solutions that could be contactingthe patient's skin and making the skin more susceptible to pressureinjury.

In some embodiments, as shown in FIG. 12, the construction of a sheet offabric 32 with friction-enhancing elements 34 that are three-dimensionaland that directly oppose each other on both sides of the fabric and withholes or uncoated spaces 40 in between the friction-enhancing elements34, may be made by starting with a scrim 42, which can be a fabric scrimmade of polyester or other suitable fibers. The threads 44 of the scrim42 may be woven or knitted into a pattern such as a checkerboard patternfor example, with open spaces 46 between the matrix of threads 44. Theopen spaces 46 between the threads may be between about 0.05 inches andabout 0.25 inches in diameter. In open spaces 46, similar to the blackspaces on a checkerboard, additional threads 48 may be added during theweaving or knitting process. As shown in FIG. 9, when a foamed PVCcompound is coated onto this scrim 42 sheet of fabric 32, the liquid PVCsticks to the spaces where additional threads 48 were added and openholes or uncoated spaces 40 are formed in the open spaces 46 whereadditional threads were not added. The foamed PVC naturally andadvantageously forms friction-enhancing elements 34 that can bethree-dimensional friction-enhancing elements directly opposing eachother on each side of the sheet of fabric 32 where the additionalthreads 48 were added and leaves holes or uncoated spaces 40 in betweenthe friction-enhancing elements 34 (Kittrich Corp.).

In some embodiments, the area of one hole 40 may advantageously be lessthan the area of one of the friction-enhancing elements 34. In someembodiments, the area of one of the holes 40 may advantageously be lessthan 0.1875 square inches. Holes 40 that are larger than 0.1875 squareinches disadvantage both the area of skin supporting the weight of thepatient's body and the natural tackiness between the friction-enhancingelements 34 and the skin. Further, holes 40 that are larger than 0.1875inches square may create a hydrostatic pressure gradient within thepatient's skin protruding into the hole 40 resulting in a pattern ofpetechiae or bruising.

In some embodiments, as shown in FIG. 10, the friction-enhancingelements 34 formed on the (e.g., open weave) scrim 42 sheet of fabric 32are approximately 0.125 inches in total thickness. Suchfriction-enhancing elements 34 can be foamed PVC three-dimensionalfriction-enhancing elements. Applicant has found that these 0.125 inchthick dots or beads in a matrix formation with spaces in between thedots may cause mild petechiae (bruising or extravasation, blood leakinginto the unsupported skin tissue that is pressed into the open spaces ofthe checkerboard pattern). This problem with petechiae may be mitigatedby flattening at least the friction-enhancing elements 34 on the uppersurface 36 of the sheet of fabric 32 when those friction-enhancingelements 34 are rounded three-dimensional friction-enhancing elements.In some embodiments, as shown in FIG. 13, the sheet of fabric 32 withfriction-enhancing elements 34 that are foamed PVC three-dimensionalfriction-enhancing elements and that have open spaces 46 therebetweencan be flattened by running it through a heat laminating process thatmay flatten the three-dimensional dots from approximately 0.125 inchesin thickness to approximately 0.05-0.10 inches in thickness. In somecases, each open space 46 is shown individually in the drawings asreference numerals 46A and 46B. Flattening the foamed PVCthree-dimensional friction-enhancing elements does not close thecheckerboard of holes 40 between the friction-enhancing elements 34 butit does make the holes 40 slightly smaller in surface area compared tothe surface area of the adjacent friction-enhancing elements 34. In someembodiments, a heat laminator may heat the sheet of fabric 32 beforerunning it through two compression rollers. Alternately, the sheet offabric 32 may be run through two compression rollers of which one orboth are heated. The flattened friction-enhancing elements 50 (which canbe foamed PVC three-dimensional friction-enhancing elements) havingholes 40 of smaller diameter therebetween, may not cause petechiae butalso do not grip the patient as effectively.

Where the friction-enhancing elements 34 are foamed PVCthree-dimensional friction-enhancing elements, flattening thesefriction-enhancing elements 34 in a heat laminator process also altersthe surface characteristic of the foamed PVC material, making itsubstantially stickier. The heating and compression process disrupts thenormal “skin” that forms on the surface of foam as it cures. Disruptingthe surface “skin” exposes the “stickier” inner foam. The stickier PVCfoam further increases the coefficient of friction between the underbodysupport 16 and the patient 2. The “stickier” PVC foam may stick to thepatient better than the skinned foam but it does not stick as well toadhesives. The exposed plasticizer in the foam interferes with theadhesion of adhesives. Therefore, if pieces of the sheet of fabric 32are intended to be adhesively bonded to the draw sheet 76 or othermaterials, it may be advantageous to adhesively bond to thenon-compressed side of the sheet of fabric 32. The original “skin”characteristic of the foamed PVC material on the lower surface 38 helpswith adhesive bonding. The stickier foam PVC in the presence of heatfrom the underbody support 16 and pressure from the weight of thepatient 2, may leave an unsightly residue of foam adhered to theunderbody support 16. In some embodiments, this adhesion residue may beprevented by heating and flattening the friction-enhancing elements 34on the upper surface 36 of the sheet of fabric 32, while leaving theoriginal “skin” characteristic of the foamed PVC material on the lowersurface 38 substantially unchanged and less sticky. The original “skin”characteristic of the foamed PVC material on the lower surface 38 helpsto prevent the residue of foam from adhering to the underbody support16.

In some embodiments, as shown in FIG. 14, the flattening of thefriction-enhancing elements 34 to form friction-enhancing elements 50 onthe upper surface 36 of the sheet of fabric 32 can be accomplished byheating the upper surface and/or heating the upper compression roller orboth. In some embodiments, the original structure, shape and surfaceintegrity of the friction-enhancing elements 34 on the lower surface 38of the sheet of fabric 32 may be preserved by heating the upper surfaceand minimally heating the lower surface and/or cooling the lowercompression roller during the compression process.

In some embodiments, the sheet of fabric 32 with friction-enhancingelements 34 (which can be foamed PVC three-dimensionalfriction-enhancing elements) and having uncoated spaces or holes 40therebetween, can be flattened and thinned by running it through aheated compression process. The heated compression process mayadvantageously produce a patient securement device with very littlethickness (compared to conventional thick foam pad securement devices)yet retain most of the gripping characteristics.

In some embodiments, the underbody support 16 may also serve as acapacitive coupling electrosurgical grounding electrode. Effectivecapacitive coupling requires that the two electrical conductors beseparated by only a thin dielectric (electrical insulator). Capacitivecoupling of RF electrical energy is most efficient and effective whenthe patient's skin is separated from the grounding antenna by a thindielectric or electrical insulating material. A thick dielectric, forexample greater than 0.5 inches, will prevent effective capacitivecoupling electrosurgical grounding. The friction-enhancing elements 34(which can be three-dimensional friction-enhancing elements) on thesheet of fabric 32 of the present disclosure create a thin dielectric.The thickness of this dielectric may be further decreased by heating andcompressing the friction-enhancing elements 34 between two rollers asdescribed above in order to form flattened friction-enhancing elements50, which further enhances the effectiveness of the capacitive coupling.In some embodiments, the thin nature of the sheet of fabric 32 of theinstant invention (such as less than 0.125 inches thick), allowseffective capacitive coupling electrosurgical grounding. The capacitivecoupling may be even further enhanced by the holes or uncoated spaces 40that are formed between the friction-enhancing elements 34, 50, wherethere is no added electrical insulating (dielectric) properties causedby the sheet of fabric 32. The invention of this disclosure is uniquelysuited for use with capacitive coupling electrosurgical grounding. Incontrast, the conventional (e.g., thick foam) securement pads 26 preventeffective capacitive coupling from occurring.

In some embodiments, the total thickness of each of the (e.g.,three-dimensional) friction-enhancing elements 34 on both the upper 36and lower 38 surfaces of the sheet of fabric 32 is less than 0.25inches. In some embodiments, as shown in FIG. 15, a layer of flexiblefoam material 52 is adhesively laminated to the upper surface 36 of thesheet of fabric 32. In some cases, the layer of flexible foam material52 is less than 0.75 inches thick. Laminating a layer of flexible foammaterial 52 to the sheet of fabric 32, substantially increases thestrength, stability and tear resistance of the layer of flexible foammaterial 52. The minimal thickness of the resulting patient securementoverlay 54 compared to known securement pads, eliminates the bolstereffect that would occur with a thicker non-weight bearing foamsurrounding the patient especially at the shoulders. When the layer offlexible foam material 52 is relatively thin, the patient cannotappreciably sink into the foam so as to create a bolster effect. This isadvantageous because effectiveness of patient securement by a bolstereffect is limited by the patient's weight and the shape of theirshoulders. For example, heavy patients and rounded shoulders canovercome the ability of a bolster to prevent sliding.

In some embodiments, minimizing or even eliminating any weight-limitedpatient securing bolster effect in the patient securement overlay 54 bylimiting the thickness to less than 0.75 inches, results in a patientsecuring effectiveness that is determined nearly exclusively by thecoefficient of friction between the patient and the patient securementoverlay 54. Coefficient of friction is by definition, independent of thepatient's weight. In some embodiments, due to the physical properties ofthe coefficient of friction, the effectiveness of this patientsecurement device is independent of the patient's weight and is onlylimited by the angle of the decline. Therefore, due to the physicalproperties of the coefficient of friction, the patient securement deviceof the instant disclosure can accommodate patients of any size orweight, without limitation. The instructions for use of this device mayonly limit the angle of decline. Most known bolster-type patientsecurement devices are limited to certain weights, usually 300-400pounds. The instructions for use of bolster-type devices limit both theangle of decline and weight of the patient.

In some embodiments, as shown in FIGS. 7A and 7B, the patient securementoverlay 54 is advantageously anchored to at least a portion of the footend of the section 12 of the surgical table mattress 30 that supports atorso of a patient 2 on a surgical table 4. In some embodiments, thepatient securement overlay 54 is advantageously anchored to at least aportion of the foot end 10 of the underbody support 16. Anchoring thepatient securement overlay 54 to at least a portion of the foot end 10of the section 12 of the surgical table mattress 30 or underbody support16 that supports the patient's torso creates a positive coupling betweenthe two layers, when the patient is in the Trendelenburg position. Sincea section 12 of the surgical table mattress 30 or underbody support 16can be positively anchored to the surgical table 4 and the patientsecurement overlay 54 can be positively anchored to at least a portionof the foot end 10 of the underbody support 16 or to the surgical tablemattress 30, the patient securement overlay 54 is thus positively anduniquely, indirectly anchored to the surgical table 4.

As shown in FIG. 3, the foot end 10 of the section 12 of the surgicaltable mattress 30 that supports the patient's torso on a surgical table4 typically includes a perineal cutout 14 in the center of the foot endof section 12 of the surgical table mattress 30. The perineal cutout 14of the section 12 of the surgical table mattress 30 is typically atapering 3-6 inch recess in the foot end of the surgical table mattress30 that is typically 10-14 inches wide at the open side of the recessand 4-8 inches wide at the closed side of the recess. Lateral to eachside of the perineal cutout 14 are side extensions 56 of the surgicaltable mattress 30. The side extensions may extend approximately 4-6inches out from each side of the perineal cutout 14. The perineal cutout14 allows the patient's perineum to hang slightly over the end of thecenter of the surgical table mattress 30 while allowing side extensions56 to provide support on the lateral aspects of the buttock when thepatient's legs are up in stirrups. The perineal cutout 14 aids inunobstructed access to the perineum by the surgeon or robot.

In some embodiments, the perineal cutout 14 of the underbody support 16may be a tapering 3-6 inch recess in the foot end of the underbodysupport 16 that may be 10-20 inches wide at the open side of the recessand 4-12 inches wide at the closed side of the recess.

In some embodiments, as shown in FIGS. 7A and 7B, the patient securementoverlay 54 is advantageously anchored to at least a portion of the footend 10 of the section 12 of the surgical table mattress 30 or underbodysupport 16 that supports the patient's torso on a surgical table 4, by afoot end extension 58 of the sheet of fabric 32 that wraps around atleast a portion of the foot end 10 of the surgical table mattress 30 orunderbody support 16 and is secured under the surgical table mattress 30or underbody support 16. In some embodiments, the foot end extension 58is a separate piece of material that is added to the patient securementoverlay 54 as the anchor section.

In some embodiments, the width of the foot end extension 58 is less thanthe width of the patient securement overlay 54. In some embodiments, thewidth of the foot end extension 58 is advantageously approximately equalto the width of the closed side of the recess of the perineal cutout 14of the surgical table mattress 30 or the underbody support 16. In someembodiments, the width of the foot end extension 58 may be between 4 and20 inches. In some embodiments, the width of the perineal cutout 14 ofthe underbody support 16 may be greater than a width of the perinealcutout 14 of the surgical table mattress 30. When the perineal cutout 14of the underbody support 16 is wider than the width of the perinealcutout 14 of the surgical table mattress 30, this may advantageouslyallow a wider and thus stronger foot end extension 58 of the sheet offabric 32 to wrap around the perineal cutout 14 of the underbody support16 and still fit within the perineal cutout 14.

In some embodiments, wrapping the foot end extension 58 of the sheet offabric 32 around the closed side of the perineal cutout 14 providessignificantly greater security than wrapping the foot end extension 58around the foot end 10 of the section 12 of the surgical table mattress30 that supports the patient's torso. First, the side extensions 56 ofthe section 12 of the surgical table mattress 30 on each side of theperineal cutout 14 create a buttress effect, preventing the upper edgeof the closed side of the perineal cutout 14 from collapsing toward thehead end when the patient is in the steep Trendelenburg position.Second, the weight of the patient's buttock centered directly over thearea adjacent the closed side of the perineal cutout 14, focuses thisweight on the exact area under the underbody support 16 that isanchoring the foot end extension 58. All other known surgical mattresscovers and sheets are designed to cover the entire mattress whichincludes the side extensions 56 of the surgical table mattress on eachside of the perineal cutout 14 as well as additional mattress sectionsat the head and foot end of the surgical table 4. In some embodiments,foot end extension 58 of the sheet of fabric 32 for anchoring the sheetof fabric 32, is wrapped around the closed side of the perineal cutout14 for maximum security and strength.

In some embodiments, the patient securement overlay 54 is advantageouslyanchored to at least a portion of the head end 62 of the section 12 ofthe surgical table mattress 30 or underbody support 16 that supports thepatient's torso, by a head end extension 60 of the sheet of fabric 32that wraps around at least a portion of the head end 62 of the section12 of the surgical table mattress 30 or underbody support 16 thatsupports the patient's torso and is secured under the surgical tablemattress 30 or underbody support 16. In some embodiments, the head endextension 60 for anchoring the head end of the patient securementoverlay 54 is a separate sheet of fabric that is added as an extensionto the sheet of fabric 32.

In the Trendelenburg position, the force vector of the patient's weightis applied parallel to the direction of the sheet of fabric 32 thatwraps around at least a portion of the foot end 10 of the section 12 ofthe surgical table mattress 30 or underbody support 16 that supports thepatient's torso. In some embodiments, the anchoring mechanism of thisinvention, the foot end extension 58 of the sheet of fabric 32 thatwraps around at least a portion of the foot end 10 of the section 12 ofthe surgical table mattress 30 or underbody support 16 that supports thepatient's torso and is secured under the surgical table mattress 30 orunderbody support 16, is applying a force vector that is directlyopposite the direction of the force applied by the patient's weight whenthe patient is in the Trendelenburg position. The positive couplingprovided by the foot end extension 58 of the sheet of fabric 32 thatwraps around at least a portion of the foot end 10 of the section 12 ofthe surgical table mattress 30 or underbody support 16 that supports thepatient's torso and is secured under the surgical table mattress 30 orunderbody support 16 does not stretch or flex and thereforesubstantially limits (e.g., does not allow) slippage or deformationbetween the patient securement overlay 54 and the surgical tablemattress 30 or underbody support 16. In some embodiments, the anchoringmechanism of this disclosure at the foot end 10 of the section 12 of thesurgical table mattress 30 or underbody support 16 that supports thepatient's torso, creates an anchoring force vector that isadvantageously directly opposite the force vector of the patient slidingdown the incline of the surgical table 4 in the Trendelenburg position.This is in contrast to known securement pads 26 where the anchoringforce vector is sideways or perpendicular to the force vector of thepatient sliding down the incline of the surgical table 4 in theTrendelenburg position. A perpendicular force vector to prevent slidingis not nearly as secure as a parallel force vector.

In some embodiments, the portion of the sheet of fabric 32 that wrapsaround at least a portion of the foot end 10 of the section 12 of thesurgical table mattress 30 or underbody support 16 that supports thepatient's torso is narrower than a width of the sheet of fabric 32.Advantageously, in some embodiments, the portion of the sheet of fabric32 that wraps around at least a portion of the foot end 10 of thesection 12 of the surgical table mattress 30 or underbody support 16that supports the patient's torso is approximately as wide as the widthof the base or closed side of the perineal cutout 14 at the foot end 10of the section 12 of the surgical table mattress 30 or underbody support16 that supports the patient's torso. The reinforced nature of theperineal cutout 14 provides a more secure anchoring location than theflat end of a surgical table mattress 30 or underbody support 16 withouta perineal cutout 14 could provide. The side extensions 56 of a surgicaltable mattress 30 or underbody support 16 adjacent the sides of theperineal cutout 14 provide reinforcement to the perineal cutout 14opposing the force vector of the patient sliding down the incline of thesurgical table 4 in the Trendelenburg position.

In some embodiments, the foot end extension 58 and head end extension 60of the sheet of fabric 32 for respectively wrapping around at least aportion of the foot end 10 and head end 62 of the surgical tablemattress 30 or underbody support 16, includes one or more elements thatimprove the friction bond between the foot end extension 58 and head endextension 60 and either or both of the underside of the underbodysupport 16, the section 12 of the surgical table mattress 30 thatsupports the patient's torso and/or the surgical table top 64. In someembodiments, the one or more elements that improve this friction bondinclude a low tack adhesive or three-dimensional friction-enhancingelements, that can be plastic or rubber, applied to the foot endextension 58 and head end extension 60 of the sheet of fabric 32.

Any low tack adhesives known in the art can be used to improve thisfriction bond, including but not limited to those adhesives used onPost-it Notes® (3M Corporation), for example. Plastic or rubberthree-dimensional friction-enhancing elements that can be used includebut are not limited to: silicone, viscoelastic polyurethane foams,viscoelastic PVC foams, other viscoelastic polymeric foams, urethane,PVC, as well as other polymers and rubbers. The friction-enhancingelements 34, which can be three-dimensional friction-enhancing elements,may be applied to foot end extension 58 and head end extension 60 of thesheet of fabric 32, or may be a separate piece of fabric that isadhesively bonded, heat bonded, or sewn to the sheet of fabric 32forming foot end extension 58 and head end extension 60.

As shown in FIG. 16, in some embodiments the one or more elements thatimprove the friction bond between the sheet of fabric 32 or the foot endextension 58 and head end extension 60 and any or all of the undersideof the underbody support 16, the surgical table mattress 30, and thesurgical table top 64 include Velcro, snaps, or hooks. In someembodiments, as shown in FIG. 17, the foot end extension 58 at the footend of the sheet of fabric 32 includes an anchor 66. In some cases, theanchor 66 is made of a flat and stiff material, such as a piece ofplastic, metal, fiberboard or other suitable flat and stiff material. Asdefined herein, “stiff” refers to the ability of the anchor 66 toprevent deformation by a given force at room temperature, that is equalto or greater than the force necessary to deform a similar sized pieceof low-density polyethylene (LDPE) that is 0.03125 inches thick ( 1/32inches). The anchor 66 may be any size or shape. In some embodiments,the anchor 66 is a rectangular (or substantially rectangular) shape,between 2 and 8 inches long and between 4 and 20 inches wide. In someembodiments, the width of the anchor 66 corresponds to the width of thebase or closed side of the perineal cutout 14 at the foot end 10 of thesection 12 of the surgical table mattress 30 or underbody support 16that supports the patient's torso.

As shown in FIGS. 17 and 18, in some embodiments, the foot end extension58 at the foot end of the sheet of fabric 32 includes the anchor 66. Insome cases, the anchor 66 comprises one or more anchor plates 67 made ofa flat and stiff material (e.g., plastic, metal, fiberboard, or othersuitable materials). As defined herein, “stiff” refers to the ability ofthe anchor 66 to prevent deformation by a given force at roomtemperature, that is equal to or greater than the force necessary todeform a similar sized piece of low-density polyethylene (LDPE) that is0.03125 inches thick ( 1/32 inches). The anchor plate 67 can besubstantially rectangular or can have any other suitable shape. In someembodiments, the anchor plate 67 may be made of low-density polyethylene(LDPE) approximately 0.0625 inches thick ( 1/16 inches). In someembodiments, the anchor plate 67 may be attached to the foot end of thesheet of fabric 32 or foot end extension 58 by inserting it into a pouch68 formed near the foot end to create anchor 66. The pouch 68 may beformed by folding the distal end of the sheet of fabric 32 or foot endextension 58 back on itself. Alternately, the pouch 68 may be formed byadding an additional piece of fabric to the distal end of the sheet offabric 32 or foot end extension 58. In some embodiments, the pouch 68may be formed by surrounding some or all of the perimeter of the anchorplate 67 with an RF seal, an ultrasound seal, a heat seal, an adhesivebond, or sewing to create a seal 82 between the two layers of the sheetof fabric 32 or foot end extension 58 covering the anchor plate 67 so asto thereby form pouch 68.

In some embodiments, as shown in FIG. 19, the anchor 66 may be createdby attaching one or two anchor plates 67 to one or both sides of thedistal end of the sheet of fabric 32 or foot end extension 58. Theanchor plate 67 may be substantially rectangular or can have any othersuitable shape. The anchor plate 67 can be made of plastic, metal,fiberboard, or other suitable material. The anchor plate 67 may furtherinclude friction-enhancing elements 72. The friction-enhancing elements72 can comprise plastic or rubber, for example. The friction-enhancingelements 72 include but are not limited to: PVC foams, viscoelastic PVCfoams, silicone, viscoelastic polyurethane foams, other viscoelasticpolymeric foams, urethane, PVC, as well as other polymers and rubbers.The one or two anchor plates 67 (that can, for example, compriseplastic, metal or fiberboard) may be attached to one or both sides ofthe distal end of the sheet of fabric 32 or foot end extension 58 bysewing, adhesive bonds, thermal and RF welds, rivets, staples, Velcro,or other suitable attachments.

In some embodiments, as shown in FIG. 18, the anchor 66 (which may beflat and stiff) can be inserted between the bottom of the surgical tablemattress 30 and the surgical table top 64 or between the underbodysupport 16 and the surgical table mattress 30. The weight of thepatient's buttocks resting on the foot end 10 of the underbody support16 or section 12 of the surgical table mattress 30 that supports thepatient's torso, positively captures the anchor 66 between the surgicaltable mattress 30 and the underbody support 16 or the surgical tablemattress 30 and the surgical table top 64. The stiffness of the anchor66 prevents the upward force of the sheet of fabric 32 or foot endextension 58 at the foot end of the surgical table mattress 30 orunderbody support 16 from elevating the end of the surgical tablemattress 30 or underbody support 16, or dislodging the anchor 66 fromunder the surgical table mattress 30 or underbody support 16. The anchor66 of the present disclosure is very easy to use and yet very secure.

In some embodiments, the sheet of fabric 32 or the foot end extension 58at the foot end of the sheet of fabric 32 that joins the foot end of thesheet of fabric 32 to the anchor 66 (which can be plastic or metal), isadjustable in length to accommodate surgical table mattresses 30 ofdifferent thicknesses. Surgical table mattresses 30 are typically 2-4inches thick. As shown in FIG. 18, the neck 70 of the sheet of fabric 32or the foot end extension 58 at the foot end of the sheet of fabric 32that joins the foot end of the sheet of fabric 32 to the pouch 68containing the anchor plate 67 (which can be or comprise plastic ormetal) may be advantageously manufactured in different lengths toaccommodate surgical table mattresses 30 of different thicknesses. Forexample, a neck 70 that is two inches may be supplied to customers withsurgical table mattresses 30 that are 2 inches thick, while a neck 70that is four inches may be supplied to customers with surgical tablemattresses 30 that are 4 inches thick.

In some embodiments, as shown in FIG. 20A, the neck 70 of the sheet offabric 32 or the foot end extension 58 at the foot end of the sheet offabric 32 that joins the foot end of the sheet of fabric 32 to the pouch68 containing the anchor plate 67 (which can comprise plastic or metal),may be made 3-6 inches long to accommodate even the thickest of surgicaltable mattresses 30. In some embodiments, for example as shown in FIG.20B, a neck 70 that is five inches long may be shortened two inches bythe user to accommodate surgical table mattresses 30 that are in a rangeof between two and three inches thick, by conveniently wrapping a twoinch long anchor 66 back on itself with a half-wrap before inserting theanchor 66 under the surgical table mattress 30. In this example, a halfwrap shortens the neck 70 by approximately 2 inches. In this sameexample, as shown in FIG. 20C, if the 2 inch long anchor 66 is wrappedback on itself with a full wrap, the neck 70 that is five inches longmay be shortened approximately four inches by the user to accommodate asurgical table mattress 30 or underbody support 16 that is about oneinch thick. In some embodiments, a single size of the patient securementoverlay 54 can accommodate surgical table mattresses 30 or underbodysupports 16 of various thicknesses.

In some embodiments, as shown in FIG. 21, the neck 70 of the sheet offabric 32 or the foot end extension 58 at the foot end of the sheet offabric 32 that joins the foot end of the sheet of fabric 32 to theanchor 66, may be adjustably shortened using adjustable fasteners 90such as snaps, buttons, Velcro, hooks, buckles and straps. Otheradjustable fasteners 90 are anticipated. The adjustable fasteners 90 maybe used to shorten, gather and retain excess material in the neck 70 ofthe foot end extension 58 in order to shorten the neck 70 to match thethickness of a given surgical table mattress 30 or underbody support 16,allowing a single design to work effectively on a surgical tablemattress 30 or underbody support 16 having any thickness.

In some embodiments, the neck 70 of the sheet of fabric 32 or the footend extension 58 at the foot end of the sheet of fabric 32 that joinsthe foot end of the sheet of fabric 32 to the anchor 66 (which can beplastic, metal, fiberboard, or other suitable materials) may bestrengthened by melting and compressing the friction-enhancing elements,such as PVC foams, viscoelastic PVC foams, viscoelastic polyurethanefoams, or polyurethane foams into the form of a film. Compressing thesematerials in a heated press or RF press will collapse the foam structureand convert the material to resemble a film. The film-like structure isstronger than the foam structure and may, in some applications, be asuperior configuration for wrapping around the end of the surgical tablemattress 30 or underbody support 16.

In some embodiments, as shown in FIG. 15, the layer of flexible foammaterial 52 may be adhesively laminated to the upper surface 36 of thesheet of fabric 32. Laminating the layer of flexible foam material 52 tothe sheet of fabric 32 advantageously utilizes the positive, non-slipanchoring of the sheet of fabric 32 or foot end extension 58 wrappingaround the foot end 10 of the section 12 of the surgical table mattress30 or underbody support 16 that supports the patient's torso, positivelycapturing the sheet of fabric 32 or foot end extension 58 between theunderbody support 16 and the surgical table mattress 30 or the surgicaltable mattress 30 and the surgical table top 64. When the sheet offabric 32 is positively anchored, the layer of flexible foam material 52is also positively anchored (e.g., laminated to the upper surface of thesheet of fabric 32). This is in contrast to known pad straps 28A, 28Bthat anchor a layer of flexible foam material to the side rails 20 ofthe surgical table 4, as shown in FIG. 6. The sheet of fabric 32 alsostrengthens the layer of flexible foam material 52, allowing the layerof flexible foam material 52 to be relatively thin, for example from0.25-0.75 inches thick. The sheet of fabric 32 prevents the layer offlexible foam material 52 from tearing, stretching or deforming underthe weight of a patient that is in the Trendelenburg position.

In some embodiments, the layer of flexible foam material 52 may be anytype of suitable foam material. In some embodiments, the layer offlexible foam material 52 may be a viscoelastic urethane foam or aurethane upholstery foam. Other foam materials including otherviscoelastic foam materials are anticipated and can be used as the layerof flexible foam material 52. The layer of flexible foam material 52 mayhave any thickness between about 0.25 inches and about 3 inches. In someembodiments, the layer of flexible foam material 52 can be less than 0.5inches thick.

In some embodiments, as shown in FIG. 22, at least a portion of thebottom of the surgical table mattress 30 or underbody support 16 may bereinforced with a plate 74. The plate 74 can be a stiff or relativelystiff plate, and can be made of plastic, metal, wood, fiberboard, orother suitable stiffener. With regards to plate 74, “stiff” is definedherein as the ability to resist deformation of more than one inch, whena plate the width of a surgical mattress extends outward twelve inchesbeyond the edge of a table surface and five pounds of weight are appliedto the unsupported distal edge. The plate 74 may be located under thesurgical table mattress's foam pad, inside the protective cover ofsurgical table mattress 30. The plate 74 stabilizes the lower corner ofthe surgical table mattress 30 at the foot end 10 and may beparticularly advantageous when used in conjunction with the patientsecurement overlay 54 of the present disclosure. When the patient'sweight is supported by the surgical table mattress 30, the plate 74stabilizes the lower corner of the surgical table mattress 30 at thefoot end 10 so that it cannot bend or compress either upward or towardthe head end, in response to an upward pulling force applied from thefoot end extension 58 at the foot end of the sheet of fabric 32 that maybe tucked under the foot end of the surgical table mattress 30.

In some embodiments, the plate 74 improves the anchoring security of thefoot end extension 58 at the foot end of the sheet of fabric 32 when itis tucked under the foot end of the surgical table mattress 30. In someembodiments, the plate 74 also prevents the surgical table mattress 30,when comprised of foam, from compressing at the foot end 10. Compressingthe foot end 10 of the surgical table mattress 30 toward the head end,when the sheet of fabric 32 or foot end extension 58 is wrapped aroundthe foot end 10, can allow about 1-3 inches of patient displacement downthe decline toward the head end of the surgical table 4 in the steepTrendelenburg position.

In some embodiments, the plate 74 may approximate the size of thesection 12 of the surgical table mattress 30 that supports the patient'storso. In some embodiments, the plate 74 may be limited to an areawithin about 10-24 inches of the foot end 10 and approximate the widthof the foot end 10 of the section 12 of the surgical table mattress 30that supports the patient's torso. Other sizes for the plate 74 are alsoanticipated and within the scope of the present disclosure.

In some embodiments, a method of supporting and restricting a slidingmotion of a patient 2 on a surgical table 4 is provided. The method caninclude the steps of: (i) providing an underbody support 16 configuredto support the patient 2 on the surgical table 4, the underbody support16 including a compressible material layer having an upper surfaceconfigured to face the patient 2 opposite a base layer having a lowersurface configured to face the surgical table 4; (ii) coupling theunderbody support 16 to the surgical table 4; (iii) placing a sheet offabric 32 between the upper surface of the underbody support 16 and thepatient 2, the sheet of fabric 32 comprising friction-enhancing elements34 on one or both sides of the sheet of fabric 32, wherein the sheet offabric 32 is configured to grip both the underbody support 16 and thepatient 2 to prevent the patient from inadvertently slipping off of theunderbody support 16; and (iv) positioning the patient 2 on theunderbody support 16.

In some embodiments, as shown in FIG. 23, a draw sheet 76 may bepositioned over the underbody support 16 for lifting the patient 2 (notshown). A draw sheet 76 is an elongated sheet of fabric that ispositioned across the surgical table 4 from side to side, locatedsubstantially underneath a torso of the patient 2. The ends of the drawsheet 76 extend out to each side of the patient 2 and allow surgicalstaff to lift the patient 2 from the surgical table 4 to the gurneywhile avoiding injuries to the patient or staff. Known draw sheetsinclude a bed sheet that has been folded the long way into a long andnarrow sheet that is between about 18 and 36 inches wide and betweenabout 6-7 feet long. Draw sheets 76 can be disposable and can be madefrom either woven or nonwoven fabrics. In some embodiments, draw sheets76 that are disposable can be used and may be between 60 and 84 incheslong and between 12 and 36 inches wide.

It will be appreciated by skilled artisans that a sheet of fabric placedon top of any patient securement device, between the patient securementdevice and the patient, may reduce the effectiveness of the patientsecurement device. One reason for this is that tightly woven fabrics,such as woven cotton or polyester, may slip against the securementdevice. To address this limitation of known draw sheets, in someembodiments, the draw sheet 76 of the present disclosure mayadvantageously be made of nonwoven fabrics including but not limited topolyester fibers. Nonwoven fabrics with relatively loose fibers mayinteract with securement pads 26 (e.g., foam securement pads) or thefriction-enhancing elements 34 of the present disclosure to produce arelatively nonslip interface as compared to woven fabrics.

In some embodiments, nonwoven fabrics may be selected to use for thedraw sheet 76 because they are very strong if the fibers are orientedprimarily in the long axis of the draw sheet 76, the axis lifting theweight of the patient, while also being disposable. Additionally, insome embodiments, the non-woven fibers of the draw sheet 76 are similarto the loop portion of Velcro hook and loop fasteners. The tucked endsof the draw sheet 76 made of non-woven fibers may be positively securedto Velcro hook material that is attached to the underside of theunderbody support 16 or the underside of the surgical table mattress 30or the underside of a base sheet 106 (e.g., sheet of fabric or film).When the ends of the draw sheet 76 are tucked under the underbodysupport 16 or the underside of the surgical table mattress 30 or theunderside of the base sheet 106, the positive connection between theVelcro hooks and the draw sheet 76, which is a non-woven draw sheet inthis example, prevents the draw sheet 76 from pulling out and becomingun-tucked. This arrangement creates a very secure and reliable supportfor the tucked arms of the patient.

In some embodiments, as shown in FIG. 24, the draw sheet 76 includesfriction-enhancing elements 80. The friction-enhancing elements 80 canbe three-dimensional friction-enhancing elements and can be (orcomprise) plastic or rubber. The friction-enhancing elements 80 includebut are not limited to: PVC foams, viscoelastic PVC foams, silicone,viscoelastic polyurethane foams, other viscoelastic polymeric foams,urethane, PVC, as well as other polymers and rubbers. Thefriction-enhancing elements 80 may be applied only to a top surface ofthe draw sheet 76 or may be applied only to a bottom surface of the drawsheet 76 or may be applied to both the top and bottom surfaces of thedraw sheet 76. The friction-enhancing elements 80 on the upper surfaceof the draw sheet 76 may be located near the center of the draw sheet76, in a location that will most likely contact a back of the patient 2.The friction-enhancing elements 80 applied in a central area of the topsurface of the draw sheet 76 corresponding to a location of thepatient's back, may provide a similar coefficient of friction betweenthe draw sheet 76 and the patient's back as would have been provided bythe sheet of fabric 32 and the patient's back, had the draw sheet 76 notbeen interposed.

The friction-enhancing elements 80 may be applied to the upper and/orlower surfaces of the draw sheet 76, between the ends 78 of the drawsheet 76 and the central region contacting the patient. Thefriction-enhancing elements 80 applied between the ends 78 of the drawsheet 76 and the central region contacting the patient, increase thecoefficient of friction between the draw sheet 76 and the surgical tablemattress 30, the underbody support 16, or the surgical table top 64.Adding the friction-enhancing elements 80 to the ends 78 of the drawsheet 76 substantially increases the force required to pull the ends 78of the draw sheet 76, when tucked, out from between the surgical tablemattress 30, the underbody support 16, or the surgical table top 64. Thefriction-enhancing elements 80 applied between the ends 78 of the drawsheet 76 and the central region contacting the patient, help to preventthe ends 78 of the draw sheet 76 from inadvertently pulling out frombetween the surgical table mattress 30, the underbody support 16, or thesurgical table top 64, to help prevent the patient's arms from droppingand becoming injured.

In some embodiments, as shown in FIG. 25, the draw sheet 76 includes asmall piece of the sheet of fabric 32 material previously described,that includes the friction-enhancing elements 34 that can bethree-dimensional friction-enhancing elements. The small piece of thesheet of fabric 32 material may be about 24 inches square, for example,and may be attached to the central area of the top surface of the drawsheet 76 by an RF seal, heat seal, sewing, or adhesive attachment. Othersizes and shapes of the small piece of the sheet of fabric 32 materialattached to the draw sheet 76 are anticipated. The friction-enhancingelements 80 on the top of the draw sheet 76 engage the patient's back inthe same manner as the friction-enhancing elements 34 on the sheet offabric 32. Therefore, effectiveness of the securement by the sheet offabric 32 is not adversely affected by interposing the draw sheet 76 ofthe instant disclosure between the sheet of fabric 32 or any other knownsecurement pad 26, and the patient's back.

Attaching the small piece of the sheet of fabric 32 withfriction-enhancing elements 34, which can be three-dimensionalfriction-enhancing elements, to the draw sheet 76, allows the draw sheet76 to be a strong, non-stretching non-woven fabric material capable oflifting a patient weighing up to 300 pounds. At the same time, a smallpiece of the sheet of fabric 32 with friction-enhancing elements 34 thatcan be three-dimensional friction-enhancing elements may advantageouslybe made of a scrim material for optimal formation of thefriction-enhancing elements 34 and yet the weaker scrim material is notrequired to lift the weight of the patient. This combination optimizesthe strengths of each material and complements the weaknesses of eachmaterial.

The small piece of the sheet of fabric 32 material attached to the uppersurface of the draw sheet 76 also helps to stabilize draw sheet 76 underthe patient. This prevents the sides of the draw sheet 76, from bunchingup and narrowing the draw sheet 76, in response to the patient lying onthe draw sheet 76.

In some embodiments, as shown in FIG. 26, pieces of the sheet of fabric32 material may be attached to the upper and/or lower surfaces of thedraw sheet 76, between the ends 78 of the draw sheet 76 and the centralregion contacting the patient to provide friction-enhancing elements 80that can be three-dimensional friction-enhancing elements. In somecases, each piece of sheet of fabric 32 is shown individually in thedrawings as 32A, 32B, 32C, and 32D. The pieces of the sheet of fabric 32material may be strips that are between about 0.5 and about 2 incheswide and reach substantially from one edge to another edge of draw sheet76. The pieces of the sheet of fabric 32 material may be attached to thedraw sheet 76 by RF sealing, heat sealing, sewing, or adhesiveattachment. Other sizes and shapes of the pieces of the sheet of fabric32 material are anticipated. Adding friction-enhancing elements 80,which can be three-dimensional friction-enhancing elements, to the ends78 of the draw sheet 76 substantially increases the force required topull the ends 78 of the draw sheet 76, when tucked, out from betweensurgical table mattress 30, the underbody support 16, or the surgicaltable top 64.

In some embodiments, as shown in FIG. 27, lateral extensions in the formof arm-securing flaps 84 may be added to the underbody support 16 orsection 12 of the surgical table mattress 30 that supports the patient'storso, to help support and retain the patient's arms when they aretucked by the sides of the patient. In some cases, the arm-securingflaps 84 are shown individually in the drawings as reference numerals84A and 84B. The “arms tucked” position is very common during surgicalprocedures performed in the Trendelenburg position. The arm-securingflaps 84 may advantageously be removably attached to the side edges ofthe underbody support 16 or section 12 of the surgical table mattress 30that supports the patient's torso. In some embodiments, the arm-securingflaps 84 may be permanently attached to the sides of the underbodysupport 16.

The “arms tucked” position is very common during surgical proceduresthat may not be performed in the Trendelenburg position such as cardiacsurgery. In certain procedures, for example robotic cardiac surgery, thesurgical table 4 may be tilted to one side or the other (as opposed toone end or the other as in the Trendelenburg or reverse Trendelenburgposition). This may be called a lateral tilt position. In the lateraltilt position, the patient 2 may be at risk for sliding sideways off ofthe surgical table 4. In some embodiments, the sheet of fabric 32 may beused to prevent the patient 2 from sliding sideways off of the surgicaltable 4. The sheet of fabric 32 prevents sideways sliding identically tohow it prevents longitudinal sliding previously described for theTrendelenburg position.

In the lateral tilt position, the patient 2 may be at risk for rollingsideways off of the surgical table 4. In some embodiments, thearm-securing flaps 84 may be used to prevent the patient from rollingsideways off of the surgical table 4. The arm-securing flaps 84 aresecured either to or under the underbody support 16 and the underbodysupport 16 that is secured to the surgical table 4. Therefore, thearm-securing flaps 84 are indirectly but positively anchored to thesurgical table. When the arm-securing flaps 84 are wrapped around thepatient's arms 94, especially up into the armpit near the shoulder, andheld in place by the draw sheet 76, the arm-securing flaps 84 positivelyprevent the patient 2 from rolling sideways off of the surgical table 4.Using the arm-securing flaps 84 to prevent rolling advantageouslyutilizes the fact that the arms are the most lateral or most outboundattachment point on the patient's body 2 and thus have the mostadvantageous mechanical leverage to prevent rolling. This design andmethod of preventing sideways rolling uniquely obviates the need forsafety straps placed across the patient's chest. Obviously, safetystraps across the patient's chest cannot be utilized during cardiac andthoracic surgery and thus securing the patient to the surgical table 4with the arm-securing flaps 84 is particularly advantageous during theseprocedures. Preventing sideways rolling by the arm-securing flaps 84 forother surgical procedures is also anticipated.

In some embodiments, the arm-securing flaps 84 may be made of the samematerial and generally the same construction as the underbody support 16previously discussed in this disclosure. In some embodiments, thearm-securing flaps 84 may be between about 18 and about 36 inches longand extend out from the sides of the underbody support 16 between about10 and about 24 inches. The arm-securing flaps 84 may be generallyrectangular in shape or may be stylized. For example, the arm-securingflaps 84 may taper from wide at the upper arm to narrow at the hand.

In some embodiments, the arm-securing flaps 84 may be heated. Thearm-securing flaps 84 may be heated blankets as disclosed in U.S. Pat.No. 8,772,676, which is incorporated by reference into this disclosurein its entirety. When the arm-securing flaps 84 are heated, they may bemade by enclosing a flexible sheet-like heating element in a waterproofshell made of plastic film. The shell covers the heating element andincludes two sheets of flexible plastic film material that are weldedtogether about the edges of the heating element. The shell may alsocover one or more layers of thermal insulation and one or more layers offoam padding or other protective materials. When the arm-securing flaps84 are heated, they take advantage of the available skin surface of thearms (each arm is −9% of the body surface area) in order to allow moreheat transfer to the patient preventing or treating hypothermia. Inaddition to delivering heat to the patient by heating their arms andhands, heat to the arms and hands causes vasodilatation, improving bloodflow and thus IV flow. Increased blood flow also improves the accuracyof the pulse oxymeter and any intravascular monitoring devices such asarterial lines.

In some embodiments, as shown in FIG. 28, the arm-securing flaps 84 maybe removably attached to the side edges of the underbody support 16 orsection 12 of the surgical table mattress 30 that supports the patient'storso. The arm-securing flaps 84 may have two or more attachment points,such as tabs 86, for securing the edge of each arm-securing flap 84 tothe edge of the underbody support 16. In some cases, the tabs 86 areshown individually in the drawings as reference numerals 86A and 86B. Insome embodiments, the arm-securing flaps 84 may have multiple attachmentpoints such as tabs 86 for securing the edges of the arm-securing flaps84 to the edges of the underbody support 16. Multiple attachment pointsallow adjustability of the relative positioning of the arm-securing flap84 compared to the underbody support 16 depending on which attachmentpoints are matched up with each other. For example, a short patient or apatient with very long arms may have the arm-securing flaps 84 attachedto tabs 86 that are closer to the foot end or may even extend past thefoot end of the underbody support 16 or section 12 of the surgical tablemattress 30 that supports the patient's torso. Tall patients or patientswith very long trunks, may have the arm-securing flaps 84 attached totabs that are closer to the head end of the underbody support 16 orsection 12 of the surgical table mattress 30 that supports the patient'storso. In some embodiments, the arm-securing flaps 84 may be permanentlysecured to the edge of the underbody support 16.

The attachment points may be tabs 86 or flaps made from shell materialthat extends outward from the peripheral bond of the shell. Theseattachment points or flaps may be fiber-reinforced, for example with anylon mesh, for added strength. The tabs 86 or flaps may include buttonholes 88 on the arm-securing flaps 84 or the underbody support 16 andcorresponding buttons 89 that are alignable with the button holes 88.The tabs 86 or flaps may include Velcro hooks on the arm-securing flaps84 or the underbody support 16 and correlating Velcro loops that alignwith the hooks. Straps, snaps, barbs, ties or other fasteners areanticipated. Fasteners such as buttons and snaps that have anappreciable thickness, may advantageously be positioned with the buttonfacing the surgical table mattress 30 rather than the patient.

In some embodiments, there are multiple attachment points, which can betabs 86, for securing the edges of the arm-securing flaps 84 to theedges of the underbody support 16. In this case, the position of thearm-securing flaps 84 relative to the edges of the underbody support 16is adjustable to accommodate different heights and arm lengths ofpatients and their relative position on the surgical table 4. Thearm-securing flaps 84 may be secured to any part of the edge of theunderbody support 16 and may be moved as needed to accommodate the nextpatient. In some embodiments, the arm-securing flaps 84 are attached toand not removable from the underbody support 16.

In some embodiments, as shown in FIG. 29, the arm-securing flaps 84 maybe secured to the side edges of a base sheet 106 (e.g., sheet of fabricor film) that approximates the width of the surgical tabletop 4. Thebase sheet 106 may be positioned under or over the surgical tablemattress 30 or underbody support 16 and extend substantially from oneside to the other side of the surgical table 4. The arm-securing flaps84 may be secured to the edges of the base sheet 106 with the samefasteners as disclosed above for removably attaching the arm-securingflaps 84 to the surgical table mattress 30 or underbody support 16,including but not limited to buttons, Velcro, straps, snaps, barbs, orties.

In some embodiments, the arm-securing flaps 84 may be permanentlyattached to the sides of the base sheet 106 much like saddlebags on ahorse. The permanent attachment may be accomplished by RF sealing, heator ultrasound sealing, sewing, or adhesive bonding of the arm-securingflaps 84 to the side edges of the base sheet 106. In some embodiments,the base sheet 106 may include a fiber reinforcement in the plasticfilm, with fibers such as nylon for added strength.

In some embodiments, as shown in FIG. 30, the base sheet 106 is made ofone or more layers of urethane or PVC film. In some embodiments, thearm-securing flaps 84 may be attached to each side of the base sheet 106such that their proximal sides are proximate the side edges of thesurgical table mattress 30 or underbody support 16. A second layer offilm may be attached to some or all of the base sheet 106, creating anenclosed space or bridge traversing from one arm-securing flap 84 acrossthe surgical table to the other arm-securing flap 84. In someembodiments, wires may traverse through this space to connect the heaterof one arm-securing flap 84 to the heater of the other arm-securing flap84. This connection allows a single plugin to conveniently activate bothheaters. This connection also allows a single controller to control andpower both heaters.

In some embodiments, the shell material of the arm-securing flaps 84 andthe base sheet 106 may be made of continuous layers of plastic filmextending from the distal edge of one arm-securing flap 84 to the distaledge of the other arm-securing flap 84. This construction that usescontinuous layers of shell material to create the outside shell of botharm-securing flaps 84 and the base sheet 106, may advantageously createa hermetically sealed space between the layers of shell material formingthe base sheet 106, that can house and protect wires traversing from onearm-securing flap heater to the other arm-securing flap heater. Thisconstruction that uses extensions of the shell material covering the twoarm-securing flaps 84 may allow for the manufacture of the shells of thetwo arm-securing flaps 84 and the base sheet 106 (e.g., sheet of film),with a single seal in an RF press. The continuous pieces of shellmaterial reduce the chances for errors, failures, and leaks at theattachments between the two arm-securing flaps 84 and the base sheet106.

In some embodiments, the base sheet 106 is movable along the length ofthe surgical table mattress 30 or underbody support 16, in order tooptimally position the arm-securing flaps 84 for covering the arms ofthe patient in various patient positions. For example, in the lithotomyposition with the legs up in stirrups 6, the patient is moved toward thefoot end of the surgical table 4 and the arm-securing flaps 84 may belocated substantially in the mid-section of the surgical table 4. In thesupine position, the patient is in the normal position on the surgicaltable 4 and the arm-securing flaps 84 may be located toward the head endof the surgical table 4. Depending on the position of the patient on thesurgical table 4, the arm-securing flaps 84 can be easily adjusted alongthe length of the surgical table 4 to match up with the location of thepatient's arms.

In some embodiments, as shown in FIG. 31, the arm-securing flaps 84 maybe secured to two or more base straps 108 that approximate the width ofthe surgical tabletop. The base straps 108 may be positioned under orover the surgical table mattress 30 or underbody support 16 and extendfrom one side to the other side of the surgical table. The length of thebase straps 108 may be adjustable to accommodate patients of differentwidths. The arm-securing flaps 84 may be secured to each end of the basestraps 108. In some embodiments, the base straps 108 may be incorporatedinto the base sheet 106 to allow for improved adjustability in width.

The purpose of the arm-securing flaps 84 is to provide security andsafety to the tucked arms of the patient so as to prevent the arms fromaccidentally falling backward or downward and causing brachial plexusnerve injuries; protect the arms and fingers from pressure injuries dueto pressure that may be accidentally applied by surgical equipment;protect exposed nerves such as the ulnar nerve at the elbow from appliedpressure; and securely position and retain the arms at the sides of thepatient. The arm-securing flaps 84 of the present disclosure areuniquely qualified to provide these protections.

Whether heated or not, the arm-securing flaps 84 of this disclosure maycontain layers of padded material 96, such as fibrous thermal insulationor foam materials. In conjunction with the shell materials and theheater material, the layers of internal materials provide flexiblepadding that protects the arms and fingers of the patient from outsidepressure points and accidental injury.

In some embodiments, as shown in FIG. 32, the attachment of thearm-securing flap 84 to the edge of the underbody support 16 or basesheet 106, provides a shelf 92 on which the arm 94 of the patient 2 canrest (especially if the patient is obese and their arms are hanging overthe edge of the surgical table). The shelf 92 is defined by the proximalside of the arm-securing flap 84 that is secured to the underbodysupport 16 or the base sheet 106. This shelf 92 is far more secure insupporting the weight of a heavy arm than the known arm tuck maneuvershown in FIG. 33. The known arm tuck relies entirely on the end of thedraw sheet 76 not pulling out from under the patient and dropping thearm. The known arm tuck relies on the weight of the patient forretention but has no specific retention enhancing features. In contrast,the arm-securing flap 84 of the instant disclosure, as shown in FIG. 32,reliably secures the proximal side of the arm-securing flap 84 to theunderbody support 16 or base sheet 106, rather than relying on thetucked end of a draw sheet 76 to stay securely tucked. The securityprovided by the positive connection between the arm-securing flaps 84and the underbody support 16, is vastly more reliable than the securityprovided by tucking the ends of certain known draw sheets under thepatient.

In some embodiments, a layer of foam 104, which can be a relativelystiff layer of foam, may be added inside the shell of the arm-securingflap 84, enhancing the shelf effect of the arm-securing flap 84. In someembodiments, the relatively stiff layer of foam 104 may be made of aclosed cell polyethylene, closed cell polyurethane or closed cell PVCfoam that is bendable in one direction (a simple curve) but resistsbending in two directions (a compound curve). The relative security ofthe shelf 92 created by attaching the arm-securing flap 84 to theunderbody support 16 obviates the need for metal toboggans or metal armsupports that need to be separately attached to the surgical table 4.The shelf 92 also automatically adjusts the width between the two armsupports, to fit the width of the patient. The arms of a large patienthanging over the side edges of the surgical table will be supported bythe arm-securing flap 84 extending away from the sides of the underbodysupport 16 before wrapping upward around the arms. Wider patients withlarger arms will automatically cause more of the arm-securing flap 84 tobe included in the shelf 92. Conversely, thin patients with small armsmay have their arms resting on the side edge of the underbody support 16which becomes the shelf 92.

In some embodiments, as shown in FIGS. 32 and 34, the arm-securing flap84 is wrapped around the arm from the bottom upward toward the top ofthe arm and then tucked into the armpit and the space between the arm 94and the torso 130. If the arm-securing flap 84 is too wide compared tothe circumference of the arm, the distal edge 98 of the arm-securingflap 84 may be folded back on itself, leaving the folded back distalheated surface in contact with the side of the patients torso,advantageously increasing the heat transfer surface area. In someembodiments, folding the distal edge 98 of the arm-securing flap 84 backon itself allows a substantially rectangular-shaped flap with asubstantially rectangular heater, to fit an upper arm that may have alarge circumference and a forearm and wrist that has a relatively smallcircumference. The resulting folded back area will be greater at thewrist than the upper arm but the arm 94 will be uniformly surrounded bythe arm-securing flap 84. The arm-securing flap 84, which can berectangular in shape, wraps tightly around even a substantiallycone-shaped arm by folding the excess heater near the hand (the point ofthe cone), back on itself and applying the folded back heater to theadjacent side of the torso for added heat transfer.

In some embodiments, when wrapped, the distal edge 98 of thearm-securing flap 84 at the wrist can be easily folded back on itself toreveal the hand and wrist for convenient inspection of the IV site.

In some embodiments, as shown in FIGS. 35A and 35B, the draw sheet 76may be wrapped in a conventional manner by first pulling it upward alongside the torso 130 (between the arm 94 and the torso 130) and thenwrapping it downward around the arm 94 from above and tucking it underthe underbody support 16, surgical table mattress 30, or base sheet 106.The counter-rotational wrapping of the draw sheet 76 against thearm-securing flap 84 creates a unique and exceptionally secure arm wrap.The arm-securing flap 84 wraps from the bottom upward around the arm,and the draw sheet 76 wraps from the top downward around the arm. Thearm-securing flap 84 and draw sheet 76 have their anchored edge onopposite sides of the arm and cross over each other, securing each otherin place. The arm-securing flap 84 attached to underbody support 16 orbase sheet 106 effectively neutralizes any forces from the patient's armthat could pull the tucked end of the draw sheet 76 out from its tuckedposition.

As shown in FIG. 35B, the counter-rotational wrapping of the draw sheet76 against the arm-securing flap 84 prevents substantially all of theforce that would naturally pull a conventionally tucked draw sheet outfrom under the patient. The force of an arm's weight that would normallypull a conventional draw sheet out from its tucked position under thepatient, is totally prevented by the proximal side of the arm-securingflap 84 being attached to the underbody support 16 or base sheet 106. Insome embodiments, the security of the arm wrap can be further increasedif friction-enhancing elements 80 are added to the draw sheet 76 in thetucked areas that will contact the underbody support 16, surgical tablemattress 30, or base sheet 106, to prevent accidental dislodgment of thedraw sheet 76 when the draw sheet 76 is tucked as described above.

In some embodiments, friction-enhancing elements 80 may be added to thedraw sheet 76 in areas that will contact the arm-securing flap 84, tofurther enhance the securing interaction of the counter-rotationalwrapping of the draw sheet 76 against the arm-securing flap 84. In someembodiments, the hook portion 128 of a Velcro hook and loop fastener maybe attached to the underbody support 16, surgical table mattress 30, orbase sheet 106 to create a positive connection with the non-woven fabricof the draw sheet 76 which serves as the loop portion, making accidentaldislodgment of the counter rotational connection between the draw sheet76 and the arm-securing flap 84 nearly impossible. In some cases, thehook portions 128 are shown individually in the drawings as referencenumerals 128A and 128B.

While the counter-rotational wrapping of the draw sheet 76 against thearm-securing flap 84 creates a unique and exceptionally secure wrap, itis also simple and intuitive to the user. Wrapping the arm-securing flap84 from the bottom upward around the arm is intuitive and easilyaccomplished with two hands (in contrast to other conventional armprotection devices for the surgical patient that require three hands;one hand to hold the arm and two hands to wrap the device around the armand secure it in place with straps). The arm-securing flap 84 hangingdown from the side of the underbody support 16 effectively prevents theuser from tucking the draw sheet first, prior to wrapping the arm in thearm-securing flap 84. Once the arm is wrapped with the arm-securing flap84 from the bottom upward around the arm, the draw sheet 76 is wrappedfrom the top down and tucked under the underbody support 16, surgicaltable mattress 30, or base sheet 106 in a conventional drawsheet-tucking manner that the user is already familiar with.

In some embodiments, the three panel construction of an underbodysupport 16, surgical table mattress 30, or base sheet 106 with twoarm-securing flaps 84 attached to the side edges of the underbodysupport 16 or surgical table mattress 30, as shown in FIG. 27, or to abase sheet 106 as shown in FIG. 29, or to base straps 108 as shown inFIG. 31, may be advantageous for a number of reasons compared to asingle section with a single heater construction. For example, themaximum safe temperature of an underbody support that is a heatedunderbody support is 39° C., whereas the maximum safe temperature of anarm-securing wrap that is a heated arm-securing wrap is 43° C. Having athree panel construction allows each section to be temperaturecontrolled independently and safely. The optimal construction of anunderbody support 16 or surgical table mattress 30 includes a foam padthat may be compressible but is not particularly flexible. In contrast,the optimal construction of the arm-securing flaps 84 includes a thinfibrous thermal insulation layer that is not compressible but is veryflexible for optimal wrapping and skin contact. The underbody support 16or surgical table mattress 30 can be a fixed and predictable width thatcorresponds to the width of the surgical table 4. In contrast, the widthof the arm-securing flaps 84 may advantageously be narrow for thinnerpatients and wider for bariatric patients. Arm-securing flaps 84 can bedetachable or attached to a base sheet 106 and allow adjustment forvarying patient widths and needs such as bariatric surgery.

In some embodiments, as shown in FIG. 36, a lateral extension 100 of thesheet of fabric 32 may extend outward to substantially cover thearm-securing flaps 84. The lateral extension 100 may approximate thesize of the arm-securing flap 84. In some embodiments, the lateralextension 100 may be made of the same material as the sheet of fabric32, including friction-enhancing elements and in some embodimentsincluding holes or spaces in the lateral extension 100. In someembodiments, the lateral extension 100 may be made of a differentmaterial than the sheet of fabric 32, for example a woven or non-wovenfabric that merely protects the skin of the patient's arm from directlycontacting the heated arm-securing flap 84. In some embodiments, thelateral extension 100 may be made of a non-woven fabric that has beenlaminated to a layer of polymeric film. The non-woven fabric may be madeof polyester fibers, for example, but other materials for the non-wovenfabric are anticipated. The layer of polymeric film of the lateralextension 100 may be made of polyethylene or polypropylene, for example,but other film materials are anticipated and can be used. In someembodiments, the lateral extension 100 may be made of spunbond non-wovenpolypropylene fibers of approximately 1.0-1.4 oz/sqyd, extrusion coatedon one side with a polypropylene film of 0.7-2.0 mill (0.0007-0.002inches) thick. In some embodiments, when the lateral extension 100 ismade of a different material than the sheet of fabric 32, the lateralextension 100 may be attached to the sheet of fabric 32 by an adhesivebond, a heat bond, an RF bond, or sewing.

In some embodiments, foam pads 102 may advantageously be attached to thelateral extension 100 where the elbows of the patient 2 are anticipatedto be located. The foam pads 102 help to prevent pressure from beingapplied to the ulnar nerve at the elbow as it is resting on the shelf 92created by the arm-securing flaps 84. The foam pads 102 may be made ofvisco-elastic “memory” foam for optimal padding of the elbow and arm. Insome embodiments, the foam pads 102 may be between about 0.05-1.0 inchesthick, about 4-8 inches wide, and about 6-16 inches long. In some cases,the foam pads 102 are shown individually in the drawings as referencenumerals 102A and 102B.

In some embodiments, a method of supporting, protecting, and heating thearms of a patient 2 on a surgical table 4 is provided. The methodincludes (i) providing an underbody support 16 configured to support thepatient 2 on the surgical table 4, the underbody support 16 including acompressible material layer having an upper surface configured to facethe patient 2 opposite a base layer having a lower surface configured toface the surgical table 4; (ii) coupling the underbody support 16 to thesurgical table 4; (iii) attaching arm-securing flaps 84 that compriseheated arm-securing flaps to the lateral side edges of the underbodysupport 16 or base sheet 106; (iv) placing a sheet of fabric 32 betweenthe upper surface of the underbody support 16 and the patient 2, thesheet of fabric 32 comprising friction-enhancing elements 34 on one orboth sides of the sheet of fabric 32, wherein the sheet of fabric 32 isconfigured to grip both the underbody support 16 and the patient 2 toprevent the patient from inadvertently slipping off the underbodysupport 16, and wherein the sheet of fabric 32 further includes lateralextensions 100 that substantially cover the arm-securing flaps 84; (v)positioning the patient 2 on the underbody support 16; (vi) pulling thedraw sheet 76 upward alongside the torso; (vii) wrapping eacharm-securing flap 84 comprising a heated arm-securing flap and itscorresponding lateral extension 100 around a respective arm from thebottom upward; (viii) and then wrapping the ends of the draw sheet 76downward around the arm from above and tucking it under the underbodysupport 16, surgical table mattress 30, or base sheet 106.

In some embodiments, as shown in FIG. 37, an underbody support 16, whichmay be heated, is configured to support the patient 2 (not shown) on thesurgical table 4 with arm-securing flaps 84 (which may also be heated)and may advantageously be used for surgical procedures that are notperformed in the Trendelenburg position. For example, cardiac surgerygenerally requires that the patients arms are tucked at their sides andwith the entire frontal surface of the patient “prepped,” there islittle available surface area for active surface warming. Similarly,robotic surgery of the abdomen or chest may require the arms to betucked in order to provide adequate room for the robot to be next to thepatient. Other surgical procedures are also anticipated. Warming thepatient's back and arms as well as supporting and protecting thepatient's arms, may be very desirable. If the patient is not going to beplaced in the steep Trendelenburg position, the sheet of fabric 32 withfriction-enhancing elements 34 may not be required. In this situation,the sheet of fabric 32 positioned over the underbody support 16 orsurgical table mattress 30, may be replaced by a surgical table cover110 that is modified to provide lateral extensions or barrier flaps 114that cover the arm-securing flaps 84.

In some embodiments, the surgical table cover 110 is a piece of woven ornon-woven polymeric or natural fiber fabric, sized to cover the entiretop of the surgical table mattress 112, and have enough extra materialto tuck the edges of the surgical table cover 110 under the surgicaltable mattress 112. In some embodiments, the surgical table cover 110may be sized to have about 12-18 inches of extra material on some or allsides of the surgical table mattress 112 for tucking. In someembodiments, the surgical table cover 110 is a piece of woven ornon-woven polymeric or natural fiber fabric that is laminated to a layerof plastic film to create a waterproof protector of the surgicaltabletop. In some embodiments, the surgical table cover 110 may be madeof spunbond non-woven polypropylene fibers of approximately 1.0-1.4oz/sqyd, extrusion coated on one side with a polypropylene film of0.7-2.0 mill (0.0007-0.002 inches) thick. In some embodiments, thesurgical table cover 110 is made of non-woven fibers made of polyester,polyethylene, polypropylene or rayon. In some embodiments, the surgicaltable cover 110 is made of spunlace polymeric fibers (for example,Sontara, Jacob Holm Corp.). In some embodiments, the surgical tablecover 110 is made of woven cotton or woven polymeric fibers. In someembodiments, the surgical table cover 110 may include cellulose fillermaterials. In some embodiments, the surgical table cover 110 may includeother fluid absorbing materials.

In some embodiments, the surgical table cover 110 has two slits 116 oneach side extending about 12-18 inches inward from the side edges of thesurgical table cover 110. The slits 116 create two barrier flaps 114that may correspond with the location of the arm-securing flaps 84. Theinnermost points of the slits 116, correspond roughly with the width ofthe surgical table mattress 112. When the edges of the surgical tablecover 110 have been tucked under the surgical table mattress 112, thetwo barrier flaps 114 may be left un-tucked and covering thearm-securing flaps 84. This may be especially convenient because thearm-securing flaps 84 would prevent tucking of the surgical table cover110 at that location. In some embodiments, the two barrier flaps 114covering the arm-securing flaps 84, protect the patient's arms fromresidual cleaning fluids that may be on the arm-securing flaps 84.

In some embodiments, as shown in FIGS. 35A and 35B, if the patient isnot going to be placed in the steep Trendelenburg position, the drawsheet 76 previously disclosed may not include friction-enhancingelements 80 on the upper surface of the draw sheet 76 in contact withthe patient's back. In some embodiments, the draw sheet 76 for surgicalprocedures on a flat table may still include friction-enhancing elements80 in the areas not under the patient's back, to aid in the security ofthe counter-rotating engagement with the arm-securing flaps 84 and withthe security of the tucked ends of the draw sheet 76 as previouslydescribed. In some embodiments, the friction-enhancing elements 80 nearthe ends of the draw sheet 76 may be foam plastic or rubberthree-dimensional elements applied directly to the draw sheet 76. Insome embodiments, the friction-enhancing elements 80 near the ends ofthe draw sheet 76 may be pieces of the sheet of fabric 32 materialbonded to the draw sheet with an adhesive, RF, heat or sewing bond.

In some embodiments, the hook portion of a Velcro hook and loop fastenermay be attached to the underbody support 16, surgical table mattress 12,or base sheet 106 to create a positive connection with the non-wovenfabric of the draw sheet 76 which serves as the loop portion, makingaccidental dislodgment of the counter rotational connection between thedraw sheet 76 and the arm-securing flap 84 nearly impossible. Making thedraw sheet 76 out of non-woven fabric conveniently allows the hookportion of a Velcro hook and loop fastener to adhere anywhere along itslength.

In some embodiments, as shown in FIG. 38, two chest straps 118 may beattached to the side edges of the sheet of fabric 32, or the two cheststraps 118 may be the exposed ends of a single strap extending from oneside to another side of the surgical table 4 under the sheet of fabric32. The chest straps 118 from each side can be crossed over a chest ofthe patient 2 and the free ends of the chest straps 118 can be securedtogether with Velcro or other fasteners. These chest straps 118 may bepositioned to secure a heated blanket 120 over the chest of the patient2. In some embodiments, the chest straps 118 may be made of a non-wovenfibrous material that can serve as the loop side of a hook and loop(Velcro) fastener. A piece of Velcro hook material may be attached toone or both of the chest straps 118, that can engage securely anywherealong the length of the other (e.g., non-woven) chest strap 118.

As shown in FIG. 38, the two chest straps 118 may be attached to theside edges of the sheet of fabric 32. These straps 118 may replacestraps that would otherwise be attached to the side rails 20 of thesurgical table 4 by the nurse in the operating room. Pre-attaching thesestraps 118 to the sheet of fabric 32 is convenient and saves nursingtime. In some embodiments, since the straps 118 are only intended tosecure a heated blanket 120 over the patient's chest, they are thusrelatively narrow (0.5-1.25 inches wide). The narrow straps may only becapable of securing a light object such as a heated blanket 120.Advantageously, narrow straps 118 cannot be mistaken for a safety strapmeant to secure the patient to the surgical table.

Typically the patient is anesthetized with general anesthesia whiletheir head is near the head end of the surgical table 4, to provide theanesthetist easy access to the head and airway for intubation. After theinduction of anesthesia, the patient must be moved toward the foot endof the surgical table 4 for positioning in the lithotomy position.Typically, this move is accomplished by lifting the patient off of theunderbody support 16 by lifting each side of the draw sheet 76 whilealso lifting the patient's head, shoulders, and feet. Operating roomstaff has suffered many back injuries lifting heavy patients. Heavypatients are very difficult to lift and therefore the movement may endup being more of a sliding movement rather than a lifting movement. Theproblem with sliding the patient is that sheet of fabric 32 withfriction-enhancing elements 34 as well as other foam securement pads 26are designed to prevent this sliding motion and therefore makesrepositioning of the patient quite difficult.

In some embodiments, as shown in FIG. 39, a slide sheet 122 may bepositioned over the top of the sheet of fabric 32 or other foamsecurement pad 26 to allow easy sliding of the patient toward the footend of the surgical table 4. The draw sheet 76 may be placed over thetop of the slide sheet 122 in order to facilitate sliding the patienttoward the foot end of the surgical table 4. Both the patient and thefabric side of the draw sheet 76 easily slide against the slipperysurface of the slide sheet 122 without having to be lifted, separatedfrom the sheet of fabric 32 and the friction-enhancing elements 34. Theslide sheet 122 may be made of plastic film, non-woven fabric, wovenfabric, or non-woven fabric laminated to plastic film. The plastic filmmay be polyethylene, polypropylene or other suitable plastics. Thenon-woven or woven fabrics may be made of polyester or polypropylenefibers or other suitable plastic or natural fibers. In some embodiments,the nonwoven fibrous side of the slide sheet 122 is placed upward tomaximize the slippery qualities of the slide sheet 122 and to beoptimally comfortable for the patient to lay on. In some embodiments,the ends of the slide sheet 122 may tuck under the head and foot ends ofthe underbody support 16 or surgical table mattress section 12supporting the patient's torso to help prevent the slide sheet 122 fromsliding during movement of the patient 2. In some embodiments, the endsof the slide sheet 122 may tuck under the head and/or foot ends of thesurgical table mattress 30 to help prevent the slide sheet 122 fromsliding during movement of the patient 2.

In some embodiments, the foot end of slide sheet 122 may be used tofacilitate repositioning a patient 2 from the position of sittingsideways on the surgical table 4 (e.g., for a spinal block), to layinglongitudinally on the surgical table 4. This repositioning maneuverrequires the patient to be rotated 90° while sitting, before being laidon their back. Rotating the sitting patient in this manner would beprevented by the friction-enhancing elements 34 of the sheet of fabric32 and the draw sheet 76 or other foam securement pads 26. However, ifthe patient is sitting on the slide sheet 122, rotating the patient 90°is easy to do and the sheet of fabric 32 or the draw sheet 76 or otherfoam securement pads 26 are not displaced in the process.

Once the patient has been repositioned, the slide sheet 122 must beremoved from under the patient 2 or the entire purpose of thefriction-enhancing elements 34 of the securement device or other foamsecurement pads 26 will be negated. In some embodiments, as shown inFIG. 39, the slide sheet 122 may have a perforation line 124 runninglongitudinally substantially in the middle of the slide sheet 122 fromend to end. The perforation line 124 allows the two sides of the slidesheet 122 to be separated from each other so that each side can bepulled out from under the patient independently. Each side of slidesheet 122 may advantageously be pulled out from under that side of thepatient 2 without having to cross the midline. In some embodiments, apull-tab 126 may be attached to each side of the slide sheet 122, nearthe perforation line 124, at either the head or foot end. In someembodiments, the pull-tab 126 may be positioned so that the pullingforce is directed laterally in order to pull one half of the slide sheet122 out from under the patient at a time, starting at the head end, forexample, and ending at the foot end. In some embodiments, the pull-tab126 may be positioned so that the pulling force slides the loose end ofthe slide sheet 122 over the top of the remaining slide sheet 122,separated from the friction-enhancing elements 34 by the remaining slidesheet 122, for easiest removal of the slide sheet 122 from under thepatient 2. In some embodiments, the pull-tab 126 may be a bright color,such as red or yellow, in order to remind the anesthetist to remove theslide sheet 122 from under the patient before putting the patient intothe Trendelenburg position. In some cases, the pull-tabs 126 are shownindividually in the drawings as reference numerals 126A and 126B. Thepull-tabs 126 may be extensions of the slide sheet 122 material or maybe added material attached to the slide sheet 122 near the perforationline 124.

Whereas particular embodiments of the invention have been described forthe purposes of illustration, it will be evident to those skilled in theart that numerous variations of the details may be made withoutdeparting from the invention as set forth in the embodiments describedherein.

The invention claimed is:
 1. A slide sheet for facilitating therepositioning of a surgical patient on a patient securing overlay orfoam securement pad located on a top of a surgical table, comprising: apiece of non-woven fabric or film configured to facilitate sliding ofthe surgical patient when the surgical patient is positioned on thepiece of non-woven fabric or film and configured to cover at least aportion of an upper surface of a surgical table mattress; extensions ofthe non-woven fabric or film located at a head end and/or a foot end ofthe piece of non-woven fabric or film providing material configured tobe tucked under a head end and/or a foot end of the surgical tablemattress, a surgical table mattress overlay, a patient securing overlay,or a foam securement pad; a perforation line running longitudinallysubstantially along a midline of the piece of non-woven fabric or filmfrom the head end to the foot end of the piece of non-woven fabric orfilm, the perforation line defining two opposing sections of the pieceof non-woven fabric or film, the perforation line being configured toallow the two opposing sections of the piece of non-woven fabric or filmto be separated from each other so that each can be independently pulledout from under the surgical patient; and a pair of pull-tabs, each pulltab being attached to a respective one of the two opposing sections ofthe piece of non-woven fabric or film near the perforation line ateither the head end or the foot end of the piece of non-woven fabric orfilm, the pull tabs being positioned so as to direct a pulling force ina lateral direction across the piece of non-woven fabric or film tocause the perforation line to tear and thereby separate the two opposingsections of the piece of non-woven fabric or film from each other. 2.The slide sheet of claim 1, wherein the slide sheet is configured toallow the surgical patient to be moved from a first location near a headend of the surgical table to a second location toward a foot end of thesurgical table by sliding the surgical patient on the slide sheet whenthe surgical patient is lying on the slide sheet.
 3. The slide sheet ofclaim 1, wherein the slide sheet is configured to allow the surgicalpatient to be rotated 90 degrees from a first position to a secondposition by rotating the surgical patient on the slide sheet while thesurgical patient is seated on the slide sheet, wherein when the surgicalpatient is in the first position the surgical patient is seated on theslide sheet with the legs of the surgical patient hanging off a side ofthe surgical table, and wherein when the surgical patient is in thesecond position the legs of the surgical patient are positioned toward afoot end of the surgical table.
 4. The slide sheet of claim 1, whereinthe piece of non-woven fabric or film is a non-woven fabric made ofpolypropylene, polyester, or other plastic fibers.
 5. The slide sheet ofclaim 1, wherein the piece of non-woven fabric or film is a film made ofpolyethylene, polypropylene, or other plastic.
 6. The slide sheet ofclaim 1, wherein the piece of non-woven fabric or film is made of alayer of non-woven fabric laminated to a layer of film.
 7. The slidesheet of claim 1, wherein the pull-tabs are positioned on an uppersurface of the piece of non-woven fabric or film so that a lateralpulling force on the pull-tabs loosens and slides an end of the piece ofnon-woven fabric or film over a remaining portion of the piece ofnon-woven fabric or film.
 8. The slide sheet of claim 1, wherein thepull-tabs comprise longitudinal material extensions of the piece ofnon-woven fabric or film that are folded to extend perpendicularrelative to the perforation line.
 9. The slide sheet of claim 1, whereinsome or all of the pull-tabs are colored so as to provide a visualreminder to an anesthetist to remove the slide sheet from under thesurgical patient before putting the surgical patient into aTrendelenburg position.
 10. The slide sheet of claim 1, wherein thepull-tabs comprise a designated location for grasping and pulling nearthe perforation line at either the head end or foot end of the piece ofnon-woven fabric or film so that the pulling force is directedlaterally.
 11. The slide sheet of claim 1, wherein the pull-tabscomprise a designated location for grasping and pulling at either thehead end or foot end of the piece of non-woven fabric or film so thatthe pulling force is directed laterally.
 12. A slide sheet forfacilitating the repositioning of a surgical patient on a patientsecuring overlay or foam securement pad located on a top of a surgicaltable, comprising: a piece of non-woven fabric or film configured tofacilitate sliding of the surgical patient when the surgical patient ispositioned on the piece of non-woven fabric or film and configured tocover at least a portion of an upper surface of a surgical tablemattress; a perforation line running longitudinally substantially alonga midline of the piece of non-woven fabric or film from a head end to afoot end of the piece of non-woven fabric or film, the perforation linedefining two opposing sections of the piece of non-woven fabric or film,the perforation line being configured to allow the two opposing sectionsof the piece of non-woven fabric or film to be separated from each otherso that each can be independently pulled out from under the surgicalpatient; a pair of pull-tabs, each pull tab being attached to arespective one of the two opposing sections of the piece of non-wovenfabric or film near the perforation line at either the head end or thefoot end of the piece of non-woven fabric or film, the pull tabs beingpositioned so as to direct a pulling force in a lateral direction acrossthe piece of non-woven fabric or film to cause the perforation line totear and thereby separate the two opposing sections of the piece ofnon-woven fabric or film from each other; and some or all of the pulltabs are colored so as to provide a visual reminder to an anesthetist toremove the slide sheet from under the surgical patient before puttingthe surgical patient into a Trendelenburg position.
 13. The slide sheetof claim 12, wherein the slide sheet is configured to allow the surgicalpatient to be moved from a first location near a head end of thesurgical table to a second location toward a foot end of the surgicaltable by sliding the surgical patient on the slide sheet when thesurgical patient is lying on the slide sheet.
 14. The slide sheet ofclaim 12, wherein the piece of non-woven fabric or film is a film madeof polyethylene, polypropylene, or other plastics.
 15. The slide sheetof claim 12, wherein the piece of non-woven fabric or film is made of alayer of non-woven fabric laminated to a layer of film.
 16. The slidesheet of claim 12, wherein the pull-tabs are positioned on an uppersurface of the piece of non-woven fabric or film so that a lateralpulling force on the pull-tabs loosens and slides an end of the piece ofnon-woven fabric or film over a remaining portion of the piece ofnon-woven fabric or film.
 17. The slide sheet of claim 10, wherein thepull-tabs comprise longitudinal material extensions of the piece ofnon-woven fabric or film that are folded to extend perpendicularrelative to the perforation line.
 18. The slide sheet of claim 10,wherein extensions of the non-woven fabric or film located at the headend and/or the foot end of the piece of non-woven fabric or film providematerial configured to be tucked under a head end and/or a foot end ofthe surgical table mattress, a surgical table mattress overlay, apatient securing overlay, or a foam securement pad.
 19. The slide sheetof claim 10, wherein a width of the piece of non-woven fabric or filmapproximates a width of the surgical table.
 20. The slide sheet of claim12, wherein the slide sheet is configured to allow the surgical patientto be rotated 90 degrees from a first position to a second position byrotating the surgical patient on the slide sheet while the surgicalpatient is seated on the slide sheet, wherein when the surgical patientis in the first position the surgical patient is seated on the slidesheet with the legs of the surgical patient hanging off a side of thesurgical table, and wherein when the surgical patient is in the secondposition the legs of the surgical patient are positioned toward a footend of the surgical table.
 21. The slide sheet of claim 12, wherein thepull-tabs comprise a designated location for grasping and pulling nearthe perforation line at either the head end or foot end of the piece ofnon-woven fabric or film so that the pulling force is directedlaterally.
 22. The slide sheet of claim 12, wherein the pull-tabscomprise a designated location for grasping and pulling at either thehead end or foot end of the piece of non-woven fabric or film so thatthe pulling force is directed laterally.
 23. A method of using a slidesheet to facilitate the repositioning of a surgical patient on a patientsecuring overlay or foam securement pad located on a top of a surgicaltable, comprising: placing a piece of non-woven fabric or film on top ofa patient securing overlay or foam securement pad located on an uppersurface of a surgical table mattress, the piece of non-woven fabric orfilm being configured to facilitate sliding of the surgical patient whenthe surgical patient is positioned on the piece of non-woven fabric orfilm, the piece of non-woven fabric or film being sized to cover atleast a portion of the upper surface of the surgical table mattress;tucking an extension at a head end and/or a foot end of the piece ofnon-woven fabric or film under a head end and/or a foot end of thesurgical table mattress, a surgical table mattress overlay, a patientsecuring overlay, or a foam securement pad; the piece of non-wovenfabric or film having a perforation line running longitudinallysubstantially along a midline from a head end to a foot end of theextensions, the perforation line defining two opposing sections of thepiece of non-woven fabric or film; and the piece of non-woven fabric orfilm including a pair of pull-tabs, each pull tab being attached to arespective one of the two opposing sections of the piece of non-wovenfabric or film near the perforation line at either the head end or thefoot end of the extensions; placing a surgical patient on the piece ofnon-woven fabric or film in a first location and/or a first position onthe surgical table; moving the surgical patient to a second locationand/or a second position on the surgical table by sliding the surgicalpatient on the piece of non-woven fabric or film; and removing the pieceof non-woven fabric or film from under the surgical patient by pullingthe pull-tabs in a lateral direction across the piece of non-wovenfabric or film to cause the perforation line to tear, thereby separatingthe two opposing sections of the piece of non-woven fabric or film, andthereafter pulling each of the two opposing sections out from under thesurgical patient.
 24. The method of claim 23, wherein the pull-tabscomprise a designated location for grasping and pulling near theperforation line at either the head end or foot end of the piece ofnon-woven fabric or film so that the pulling force is directedlaterally.
 25. The method of claim 23, wherein the pull-tabs comprise adesignated location for grasping and pulling at either the head end orfoot end of the piece of non-woven fabric or film so that the pullingforce is directed laterally.
 26. The method of claim 23, wherein thepull-tabs comprise longitudinal material extensions of the piece ofnon-woven fabric or film that are folded to extend perpendicularrelative to the perforation line.
 27. The method of claim 23, wherein awidth of the piece of non-woven fabric or film approximates a width ofthe surgical table.
 28. The method of claim 23, wherein moving thesurgical patient to the second location and/or second position on thesurgical table involves rotating the surgical patient 90 degrees fromthe first position to the second position while the surgical patient isseated on the slide sheet, wherein when the surgical patient is in thefirst position the surgical patient is seated on the slide sheet withthe legs of the surgical patient hanging off a side of the surgicaltable, and wherein when the surgical patient is in the second positionthe legs of the surgical patient are positioned toward a foot end of thesurgical table.
 29. The method of claim 23, wherein the piece ofnon-woven fabric or film is a non-woven fabric made of polypropylene,polyester, or other plastic fibers.
 30. The method of claim 23, whereinthe pull-tabs are positioned on an upper surface of the piece ofnon-woven fabric or film so that a lateral pulling force on thepull-tabs loosens and slides an end of the piece of non-woven fabric orfilm over a remaining portion of the piece of non-woven fabric or film.